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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197409137
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:47:04 PM

Unsubstantiated


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
05/14/2024 and conducted by Evaluator Mayra Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240514112550
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: 22DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Angelica Rodriguez, DirectorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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On Wednesday, June 12, 2024, at 2:10 p.m., Licensing Program Analyst (LPA), Mayra Rivera conducted an unannounced complaint inspection regarding facility staff did not ensure reporting requirements were followed.
LPA entered infant 1 classroom and observed 5 infants with staff 1 and staff 4. LPA entered infant classroom 2 and observed 4 infants with staff # 3. LPA entered toddler classroom and observed 12 toddlers with staff 5 and staff 6.
During the course of this investigation, Licensing Program Analyst Mayra Rivera conducted interviews with parents, and staff, and reviewed documentation. LPA was not able to interview children due to being nonverbal. All parents stated that they have no concerns with the quality of care provided at Notre Dame. Facility provided proof of notice being sent to the assigned toddler classroom via app Childpilot on May 10, 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 2
Control Number 12-CC-20240514112550
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: 06/12/2024
NARRATIVE
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LPA observations and interviews conducted did not support nor confirm the above allegation. This agency has investigated the complaint. At this time, it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore at this time the above allegation is unsubstantiated. No deficiency given at this time.

Exit interview was conducted with director Angelica Rodriguez. The director was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2