CITY OF CARSON COMMUNITY SERVICE CENTER

Type B citation from complaint investigation - potential risk if not corrected

Type B citation - potential risk if not corrected

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) LPA Ashley Calderon arrived to the facility. The purpose of the inspection was to conduct a complaint inspection. Due to LPA observations, interview, and record review LPA conducted a Case Management inspection. Incident was reported by the facility on 10/2/24 via telephonically to caseload LPA Susan Sanchez, failed to report to the Department within the next working day. Per Facility Director notified LPA Calderon Child #1 parents spoke to her on 9/26/24 regarding incident that took place on 09/24/24. As of 10/8/24 at 11:33am, written incident report was not submitted to Licensing within the 7 day time frame. The following deficiencies listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR. An exit interview was conducted with Staff/ Director Raquel Riviera, Appeal Rights and Notice of Site visit was given. SUPERVISORS NAME: Valarie Cook LICENSING EVALUATOR NAME: Ashley Calderon LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024 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 2 FACILITY NAME: CITY OF CARSON COMMUNITY SERVICE CENTER FACILITY NUMBER: 191606870 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/08/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/08/2024 Section Cited CCR 101212 1 2 3 4 5 6 7(d) Upon...occurrence, during the operation of...center of any of the events specified...below, a report shall be made to the Depart. by telephone or fax within... next working day...during its normal business hours. In addition, a written report containing the information specified in (d)(2)...1 2 3 4 5 6 7Director provided LPA with City of Carson In House Incident Report and Staff Statements. In addition, Director will submit to Licensing Via email on 10/8/24, LPA provideded the LIC624 Unusal Incident Report and Regulation on reporting requirement. 8 9 10 11 12 13 14below shall be submitted to the Department within seven days following the occurrence of such event. The requirement was not met as evidanced by: Director Raquel during itnerviewed confirmed was unaware of Reporting Requirments and stated no written UIR sent to Licesning. Called Licensing caseload LPA on 10/2/24 and incident was reported on Thur. 9/26/24.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Valarie Cook LICENSING EVALUATOR NAME:Ashley Calderon LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analyst (LPA) LPA Ashley Calderon arrived to the facility. The purpose of the inspection was to conduct a complaint inspection. Due to LPA observations, interview, and record review LPA conducted a Case Management inspection. Incident was reported by the facility on 10/2/24 via telephonically to caseload LPA Susan Sanchez, failed to report to the Department within the next working day. Per Facility Director notified LPA Calderon Child #1 parents spoke to her on 9/26/24 regarding incident that took place on 09/24/24. As of 10/8/24 at 11:33am, written incident report was not submitted to Licensing within the 7 day time frame. The following deficiencies listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR. An exit interview was conducted with Staff/ Director Raquel Riviera, Appeal Rights and Notice of Site visit was given. SUPERVISORS NAME: Valarie Cook LICENSING EVALUATOR NAME: Ashley Calderon LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024 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 2 FACILITY NAME: CITY OF CARSON COMMUNITY SERVICE CENTER FACILITY NUMBER: 191606870 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 10/08/2024 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 10/08/2024 Section Cited CCR 101212 1 2 3 4 5 6 7(d) Upon...occurrence, during the operation of...center of any of the events specified...below, a report shall be made to the Depart. by telephone or fax within... next working day...during its normal business hours. In addition, a written report containing the information specified in (d)(2)...1 2 3 4 5 6 7Director provided LPA with City of Carson In House Incident Report and Staff Statements. In addition, Director will submit to Licensing Via email on 10/8/24, LPA provideded the LIC624 Unusal Incident Report and Regulation on reporting requirement. 8 9 10 11 12 13 14below shall be submitted to the Department within seven days following the occurrence of such event. The requirement was not met as evidanced by: Director Raquel during itnerviewed confirmed was unaware of Reporting Requirments and stated no written UIR sent to Licesning. Called Licensing caseload LPA on 10/2/24 and incident was reported on Thur. 9/26/24.8 9 10 11 12 13 14 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Valarie Cook LICENSING EVALUATOR NAME:Ashley Calderon LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024