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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700092
Report Date: 08/08/2022
Date Signed: 08/08/2022 02:40:25 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
05/13/2022 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 12-CC-20220513142653
FACILITY NAME:WHITE FAMILY CHILD CAREFACILITY NUMBER:
197700092
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
08/08/2022
UNANNOUNCEDTIME BEGAN:
02:07 PM
MET WITH:Earma WhiteTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Day care child received an injury while in care.
Crib was not free from objects.
INVESTIGATION FINDINGS:
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On 08/08/22 Licensing Program Analyst (LPA) Justin Dorsey conducted a complaint investigation at the facility to deliver complaint investigation findings. LPA met with Licensee Earma White, Upon arrival LPA observed 4 children with the Licensee.
During this investigation, LPA received pertinent documents related to this investigation, which included the facility children’s roster, pictures of the injury and an ouch report related to Child #1's injury. LPA also interviewed the complainant, licensee, and parents of the program. According to interviews with the licensee it was found that Child #1 was injured twice while in care. During the first incident Child #1 bumped their head on a cubby in the main care area, during the second incident Child #1 bumped their head on a toy while in their crib. Due to the child being injured on a toy in their crib both allegations have been substantiated. Based on information obtained, interviews with relevant complaint parties, licensee, and parents the allegations are deemed SUBSTANTIATED and citations will be issued. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met. During the visit LPA Dorsey also issued a Technical Violation due to the Licensee not reporting the injuries to licensing.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
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-20220513142653
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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2022
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a)(2) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Per licensee she will provide LPA Dorsey with a written statement on how she will provide safe sleep to infants by POC due date 08/15/22.
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Based on interview Child #1 bumped their head on a toy in their crib, which poses a potential Health, Safety or Personal Rights risk to children in care.
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Type B
08/15/2022
Section Cited
CCR
101439.1(f)
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101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:



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Per licensee she will make sure there are no items in the infants cribs by POC due date 08/15/22.
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Based on interview Child #1 had a toy in their crib causing injury, which poses a potential Health, Safety or Personal Rights risk to 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: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 12-CC-20220513142653
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: WHITE FAMILY CHILD CARE
FACILITY NUMBER: 197700092
VISIT DATE: 08/08/2022
NARRATIVE
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An exit interview was conducted, a copy of this report read out, notice of site visit and appeal rights was given to Licensee Earma White.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3