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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197407546
Report Date: 09/24/2024
Date Signed: 10/10/2025 05:33:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2024 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20240912110903
FACILITY NAME:NOAH'S ARK PRESCHOOL-QUARTZ HILL FOURSQUARE CHURCHFACILITY NUMBER:
197407546
ADMINISTRATOR:CASUNCAD, RECELFACILITY TYPE:
850
ADDRESS:6015 WEST AVEUNE J-8TELEPHONE:
(661) 943-4440
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: 29DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Casey HaynesTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not ensure child's records were properly maintained
INVESTIGATION FINDINGS:
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On September 24, 2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced follow-up complaint inspection and met with Director Casey Haynes. The purpose of the inspection was to deliver the findings related to complaint allegations. During the visit, LPA observed 25 children present, along with 4 teachers, 2 assistants, and the director.
As part of the investigation, LPA Heath reviewed court orders, text messages, emails, and conducted interviews with the director and all relevant individuals. The findings are as follows: Allegation #1: Staff did not properly maintain the child's records. Finding: After interviewing the director and reviewing the child's file along with the court order, the LPA identified discrepancies and missing information in the child's record.
The agency has completed its investigation. Based on the information obtained, the above allegation is deemed Substantiated. A finding of substantiated means that allegation is valid. Facility has been cited a Type B citation. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during operational hours following each visit by a licensing representative. Failure to maintain the required posting will result in a civil penalty of $100.00.
An exit interview was conducted with the Director, Casey Haynes.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/12/2024 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20240912110903

FACILITY NAME:NOAH'S ARK PRESCHOOL-QUARTZ HILL FOURSQUARE CHURCHFACILITY NUMBER:
197407546
ADMINISTRATOR:CASUNCAD, RECELFACILITY TYPE:
850
ADDRESS:6015 WEST AVEUNE J-8TELEPHONE:
(661) 943-4440
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: 29DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Casey HaynesTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did withheld child's records from child's authorized representative

INVESTIGATION FINDINGS:
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The LIC 9099A Complaint Investigation Report was amended on September 26, 2024, to correct the visit date.
On September 24, 2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced follow-up complaint inspection and met with Director Casey Haynes. The purpose of the inspection was to deliver the findings related to complaint allegations. There are 25 children present, along with 4 teachers, 2 assistants, and the director.
As part of the investigation, LPA Heath reviewed court orders, text messages, and emails and conducted interviews with the director and all relevant individuals. The findings are as follows: Allegation #2: Staff withheld the child's records from the authorized representative.Finding: After reviewing the email and text messages, it was determined that the school provided the child's records to the authorized representative in a timely manner.
The agency has completed its investigation. It has been determined that although the allegations may have occurred or are valid, there is not enough evidence to substantiate the alleged violation. Therefore, the above allegations are considered unsubstantiated, and no deficiencies have been cited at this time.
An exit interview was conducted with the licensee, Caey Haynes.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20240912110903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: NOAH'S ARK PRESCHOOL-QUARTZ HILL FOURSQUARE CHURCH
FACILITY NUMBER: 197407546
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2024
Section Cited
CCR
101221(b)(5)
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101221(b)(5): Child's record: (5) Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary. This requirement was not met as evidenced by:
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The director will reach out to the parent to complete all the required information.
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Based on observation, interview and record
review, LPA identified missing or incorrect information in child's file.This poses a potential risk to the health and safety of children in care.
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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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3