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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197750162
Report Date: 08/28/2025
Date Signed: 09/05/2025 09:31:34 AM

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
07/25/2025 and conducted by Evaluator Sherell Braddock
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20250725130418
FACILITY NAME:ACADEMY OF EXCELLENCEFACILITY NUMBER:
197750162
ADMINISTRATOR:CHAUNCY SMITHFACILITY TYPE:
830
ADDRESS:1324 WEST AVENUE J SUITE 5TELEPHONE:
(661) 206-9344
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:8CENSUS: 5DATE:
08/28/2025
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Chauncy Smith- Director TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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This is an amended report for the report issued on August 28, 2025 to make a correction to the deficiency issued.

Children received injuries do to lack of supervision
INVESTIGATION FINDINGS:
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On Thursday, August 28, 2025, Licensing Program Analyst (LPA) Sherell Braddock conducted a complaint inspection to investigate the above-referenced allegation. Upon arrival at the facility, LPA was greeted by Chauncy Smith. The purpose of the visit was discussed. Later on, Nicole Medina Joined the inspection. There were 5 children and 4 staff members present at the facility.

During the inspection, LPA conducted interviews with staff and parents.
The Department also received an Unusual Incident Report dated July 3, 2025, involving Child #1 (C1), who experienced an incident at school and was subsequently asked to remain home the following day. Later, on July 25, 2025, a formal complaint was filed alleging that C1 sustained injuries due to lack of supervision.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
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-20250725130418
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750162
VISIT DATE: 08/28/2025
NARRATIVE
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Interviews revealed that C1 and another child (Child #2) were left unsupervised while a staff member (S1) was changing a third child’s diaper. During this unsupervised period, one child scratched the other. According to the facility director, the staff member assigned to the infant room received a verbal warning and was reminded that all children must always be under supervision. Staff were also instructed to request assistance when they are unable to maintain proper supervision. C1 personal rights were violated due to S1 not requesting assistance while attending to C3.

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 personal rights violation 101223(c).

Please see LIC-9099D for more information.

An exit interview was conducted, and a signed copy of this report was provided to Director Chauncy Smith and Nicole Medina, along with her appeal rights. A Notice of Site Visit was left at the facility to be posted for 30 calendar days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20250725130418
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750162
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2025
Section Cited
CCR
101223(c)
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101223(c) Personal Rights
The licensee shall ensure that each child is accorded with the personal rights specified in this section. This requirement was not met as evidence by:
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Director provided LPA a copy of the write up that S1 recieved for Lack of Supervision
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Based on observations and interviews S1 did not comply with the section cited above and C1 personal rights were violated when C1 sustained scratches on face due to S1 not requesting assistance. This poses a potential Health, Safety, or Personal Rights risk to persons 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: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3