Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018196
Report Date: 07/12/2016
Date Signed 07/12/2016 02:26:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S COLLECTIVE INC - MAPLE STREET, THEFACILITY NUMBER:
198018196
ADMINISTRATOR:CHENIEKA MORGAN-MILLSFACILITY TYPE:
850
ADDRESS:255 EAST 28TH STREETTELEPHONE:
(310) 733-4388
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:36CENSUS: 26DATE:
07/12/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Loretta IberosiTIME COMPLETED:
12:50 PM
NARRATIVE
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This visit was conducted by Complaint Specialist-LPA Karen Chambers. This visit is related to the incident that was reported on 3/23/16 where a child may have been inappropriately touched by a staff member while in care.

During this investigation that was conducted by IB investigator Brittany Hudec, interviews were conducted staff, day-care children, the parent of the victim as well as the victim. A copy of the police report was also obtained.

During interviews with staff, they stated that they have not witnessed any inappropriate contact between staff #1 and child #1. Staff also indicated during their interviews that child #1 has a history of falsifying stories. However, staff #2 stated during their interview that they have witnessed staff #3 grab the day-care children's arms or shirt and pull then to another location.

The suspect (staff #1) during their interview denied any inappropriate contact with child #1, but did state that they could understand if the child made an allegation that they were pinched or grabbed by staff, "because accidents do happen"; but they them self deny having pinched or grabbed child #1.

During the interviews with the day-care children they denied any inappropriate contact by staff #1. But, there were statements made by day-care children, that they have witnessed child #1 being "pulled down to their bed" by staff.

During child#1 interview there were inconsistent statements made regarding being inappropriately touched by staff #1. However, child #1 was consistent in regards to having been hurt by staff #2. Child #1 informed the school when asked what happened to their arm they stated "lady in blue). This staff person was later identified as staff #2. According to child #1, staff #2 was mad.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE INC - MAPLE STREET, THE
FACILITY NUMBER: 198018196
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/13/2016
Section Cited
101223(a)(3)
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Personal Rights. Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. Based on statements made by child #1 and cooperating statements by staff and other day-
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Per Program Specialist Rocio Bach: According to Rocio, there will be a training of the staff as to how to respect the children and to review the children's rights. The facility will provide the date, content of the training & who will provide the training. A sign in sheet will be provided within a week of the training.
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care children, it has been determined during this investigation that the personal rights of child #1 have been violated by staff #2 and other staff.
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Type A
07/12/2016
Section Cited
101170(e)
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Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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Per Program Specialist Rocio Bach: insure that staff from child care careers is associated either prior to or on their 1st day at the site.
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The facility/Licensee has allowed Theyna Cockrell to be present in the facility without the required criminal background clearance. CIVIL PENALTY ACCESSED
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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: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHILDREN'S COLLECTIVE INC - MAPLE STREET, THE
FACILITY NUMBER: 198018196
VISIT DATE: 07/12/2016
NARRATIVE
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The parent of child #1 stated that they were informed for two weeks by child #1 that staff #1 had been having inappropriate contact with their child. Child #1 was consistent with their statements to parent and it was at this point they reported what was told to them to the school. Prior to this incident, child #1 stated that they had been hurt by a teacher because that teacher was "mad"

The police report indicated that there was no crime and closed their case.

Based on this investigation it has been determined that the personal rights of child #1 have been violated by staff.

It was also determined during the course of this investigation it was determined that there is no evidence of the facility/Licensee, having submitted prints for staff member Theyna Cocrell, to insure that all required clearances have been received prior to being present in the facility. CIVIL PENALTY ACCESSED.

The notice of site visit was posted where the parent/guardian of children in care enter and exit the facility. This notice shall be posted for 30 consecutive days. A copy of this report shall also be posted where the parent/guardian enter and exit the facility. The notice of site visit and this report shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children in care by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months.

Exit interview conducted with the Licensee, during which appeal rights were explained. A copy of the appeal rights (LIC9058 01/16) were provided. The Licensee’s signature on this reports acknowledges receipt of their rights.
SUPERVISOR'S NAME: Bertha ManzanaresTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Karen ChambersTELEPHONE: (323)854-7636
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2016
LIC809 (FAS) - (06/04)
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