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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493007
Report Date: 10/22/2021
Date Signed: 10/22/2021 05:47:21 PM

Unsubstantiated


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
08/09/2021 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210809124657
FACILITY NAME:MAGIC CAROUSEL MONTESSORI PRESCHOOLFACILITY NUMBER:
197493007
ADMINISTRATOR:NICOLE MEDINAFACILITY TYPE:
850
ADDRESS:17956 SIERRA HIGHWAYTELEPHONE:
(661) 298-4065
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:44CENSUS: 27DATE:
10/22/2021
UNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Shirley JohnsonTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation #4: Record Keeping: Facility has inadequate record keeping
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 20, 2021, Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced complaint subsequent inspection on the above allegation. LPA disclosed the purpose of inspection and was permitted entry by Director who guided LPA on tour of the facility. LPA counted 27 children with 7 staff present.

During this investigation, LPA interviewed Director, Staff and obtained facility records. Time sheets and child attendance records were also observed and found to be in compliance. LPA reviewed staff and child records and and found them to be complete.

Based on evidence obtained and interviews conducted, the above allegation is deemed Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations did or did not occur. An exit interview was conducted, a copy of this report, Appeal Rights, and a notice of site visit were provided to the Director, Shirley Johnson.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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