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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364843655
Report Date: 11/01/2021
Date Signed: 11/01/2021 03:30:12 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
08/13/2021 and conducted by Evaluator Linda Thompson-Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210813095955
FACILITY NAME:KIDS & CARE PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
364843655
ADMINISTRATOR:LUZ MARISOL VALENZUELAFACILITY TYPE:
830
ADDRESS:10662 MAPLE AVENUETELEPHONE:
(760) 956-2000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:16CENSUS: 8DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Luz ValenzuelaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Allegation: Care and Supervision - Day care child sustained injury while in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Thompson-Miller and Ibitoye conducted an unannounced inspection regarding the above allegation and met with Director Luz Valenzuela. Present are 8 infants and 2 staff. During the course of finalizing the investigation, LPA interviewed staff and parents, obtained evidence (photo of flooring in wash and change area of the infant room, child injury photo) pertinent to this investigation.
Staff #2 was assisting Infant wash hands after finishing eating. Staff #2 looked over to throw paper towel into the trash can, then heard the Infant fall, turned around and saw Infant was on the floor, she did not see the fall. Infant hit her head on the arm rest of a chair that was located behind the step stool leading to the sink and sustained a cut (surgical glue). Although, Staff #2 was present in close proximity to the infant who was standing on a step stool, Staff #2 did not readily assist infant while at the sink when lost her balance.The above allegation is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. LIC9099D, Type A deficiency issued according to California Code of Regulations Title 22. LIC9224 provided (Acknowledgement of Licensing Reports). An exit interview was conducted, a copy of this report was read and provided to the Director, Luz Valenzuela on this date. The Notice of Site Visit was given to Director.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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-20210813095955
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: KIDS & CARE PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 364843655
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/02/2021
Section Cited
CCR
101429(a)(1)
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101429 (a) (1) Responsibility for Providing Care and Supervision for Infants (a) (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement was not met as evidenced by: Staff did not readily assist infant when infant lost her balance.
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Facility staff no longer turn to trash container to toss paper towel. Staff toss paper towel in trash once infant is off the step stool.
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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: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20210813095955
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: KIDS & CARE PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 364843655
VISIT DATE: 11/01/2021
NARRATIVE
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Upon receipt of the Type A Violation(s), licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Linda Thompson-Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3