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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197409137
Report Date: 01/17/2024
Date Signed: 01/25/2024 01:17:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 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
10/26/2023 and conducted by Evaluator Mayra Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20231026142112
FACILITY NAME:NOTRE DAME INFANT CENTERFACILITY NUMBER:
197409137
ADMINISTRATOR:ANGELICA RODRIGUEZFACILITY TYPE:
830
ADDRESS:21704 GOLDEN TRIANGLE RD.#120TELEPHONE:
(661) 255-0053
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:30CENSUS: 18DATE:
01/17/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angelica Rodriguez, Director TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility is operating out of ratio
INVESTIGATION FINDINGS:
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On Wednesday, January 17th, at 9:15 a.m., Licensing Program Analyst (LPA), Mayra Rivera conducted an unannounced complaint inspection and delivered findings regarding facility is operating out of ratio. At approximately 9:30 am., LPA entered classroom infant 1 and observed 8 infants with 4 staff present. At approximately 9:40 am., LPA entered the toddler classroom and observed 10 toddlers with two staff present.

During the course of this investigation, Licensing Program Analyst Mayra Rivera conducted confidential interviews and reviewed documentation. During the interviews it was disclosed that there have been times when the facility has been out of ratio due to staff shortage and children were transferred to the toddler component classroom when the infant classrooms were out of ratio. It was also stated that a parent removed the child from the facility because the child was being transferred from the infant classroom to the toddler’s component classroom without consent and felt the child was not ready to be in toddler’s classroom. Documentation revealed at the time of the incidents there is no evidence to support being within ratio.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
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
Control Number 12-CC-20231026142112
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: NOTRE DAME INFANT CENTER
FACILITY NUMBER: 197409137
VISIT DATE: 01/17/2024
NARRATIVE
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In the month of October 2023, the children in the toddler’s component classroom did not have consent from the parents to be transferred, therefore all children in the toddler classroom fall under the infant ratio 1:4 or 1 full qualified teacher with two aides 1:12

The above allegation is found to be substantiated. A finding of substantiated means that the allegation has been found to be valid because the preponderance of the evidence standard has been met. Based on information obtained during this investigation, the following Type B deficiency listed on the attached LIC 809D is being cited in accordance with California Code of Regulations Title 22. The deficiency that is being cited needs to be cleared to protect the children’s health & safety.

The following citation is being cited today on the attached LIC 9099D.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “B” deficiency. The report and the Notice of Site Visit (LIC 9213) shall be posted for 30 consecutive days. Failure to maintain posting as required will result in an immediate $100 civil penalty.
The exit interview was conducted with director Angelica Rodriguez. A copy of this report and appeal rights were discussed and left with director, Angelica Rodriguez, whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20231026142112
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: NOTRE DAME INFANT CENTER
FACILITY NUMBER: 197409137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2024
Section Cited
CCR
101416.5
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Staff-Infant Ratio-There shall be a ratio of one teacher for every four infants in attendance. The licensee did not comply with the section cited above in not being in ratio which poses a potential health, safety or personal rights risk to persons in care.
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Per director Angelica, for the infant classroom combined the two classroom with qualified staff and have a daily schedule to keep track number of children and staff to give them breaks and to ensure the classrooms are within ratio.
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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: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3