Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418475
Report Date: 05/06/2016
Date Signed 05/06/2016 04:00:04 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2016 and conducted by Evaluator Tiffanie Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20160406192847
FACILITY NAME:CRYSTAL STAIRS INC.- SULLIVANFACILITY NUMBER:
197418475
ADMINISTRATOR:JONES-LOWE, CONNIEFACILITY TYPE:
850
ADDRESS:725 W. RAYMOND STREETTELEPHONE:
(310) 933-0760
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:120CENSUS: DATE:
05/06/2016
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kimberly Hargrave, Site SupervisorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Reporting Requirement- Facility failed to report an unusual incident report regarding the no plumbing in children's restroom in the back module that caused P.M. classes to cancel on 3/9/16 and 3/10/16.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Tiffanie Tran, conducted a site visit and met with Kimberly Hargrave, site supervisor to finalize the above allegations. Upon reviewing the documents and interviewing conducted with parents and staff. There was enough evidence to indicate that no plumbing in the children's restroom and for that P.M. classes were cancelled on 3/9/16 and 3/10/16. However, the facility failed to submit an unusual incident report for this event.
Based upon the weight of evidence obtained during the course of the investigation, there is sufficient evidence to establish or prove the allegation actually occurred therefore, the investigation findings have been determined to be substantiated.
Substantiated – A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Type B deficiency was cited during this visit.

An exit interview was conducted and a copy of this report was provided to site supervisor.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/06/2016 and conducted by Evaluator Tiffanie Tran
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20160406192847

FACILITY NAME:CRYSTAL STAIRS INC.- SULLIVANFACILITY NUMBER:
197418475
ADMINISTRATOR:FACILITY TYPE:
850
ADDRESS:725 W. RAYMOND STREETTELEPHONE:
(310) 933-0760
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:120CENSUS: DATE:
05/06/2016
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kimberly Hargrave, Site SupervisorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Physical Plant-The facility children's restroom shared stalls were in disrepair but staff were not properly handling the situation.

Food Service- Facility ran out of dishes detergent for the past few days. Parent volunteer was asked to rinse the used dishes with hot water and reuse the same dishes to prepare food for the children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Tiffanie Tran, conducted a site visit and met with Kimberly Hargrave, Site Supervisor to finalize the above allegations.
Upon reviewing the documents and interviewing conducted with parents, staff and children there were not enough evidence to indicate the facility staff mishandled the situation of children's restroom had no plumbing. LPA reviewed the sign/in and out the P.M classes were cancelled due to no plumbing. In addition LPA observed the facility received supplies bi-weekly. On 3/22/16, the shipment indicated 1 gallon of dish soaps were delivered to the facility.
Based upon the weight of evidence obtained during the course of the investigation, there is insufficient evidence to establish or disprove the allegations actually occurred therefore, the investigation findings have been determined to be inconclusive.
Inconclusive- A finding that the complaint is inconclusive means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

A copy of this report was explained and issued to the site supervisor.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3


Control Number 30-CC-20160406192847

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CRYSTAL STAIRS INC.- SULLIVAN
FACILITY NUMBER: 197418475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2016
Section Cited
101212 d 1 C
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Reporting Requirements. Any unusual incident or child absence that threatens the physical or emotional health or safety of a child shall be reported to the Department within 24 hours of the occurrence.
Facility failed to report no plumbing in the children's restroom that caused P.M. classes were cancelled on 3/9/16 and 3/10/16.
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Site Supervisor has subsequently provided a written unusual incident report for this incident to clear the deficiency.

Deficiency was cleared during this visit.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2016
LIC9099 (FAS) - (06/04)
Page: 2 of 3