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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 143808559
Report Date: 09/28/2021
Date Signed: 09/28/2021 11:59:04 AM



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
09/22/2021 and conducted by Evaluator Carol Heath
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210922154729
FACILITY NAME:IMACA ELM STREET PRESCHOOLFACILITY NUMBER:
143808559
ADMINISTRATOR:BRITTANY NELSONFACILITY TYPE:
850
ADDRESS:800 W. ELM ST., BLDG ATELEPHONE:
(760) 872-6832
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY:20CENSUS: 14DATE:
09/28/2021
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Amanda TatumTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
FAcility did not report a COVID outbreak
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 9/27/2021 at 11:40 PM, Licensing Program Analyst (LPA) Carol Heath initiated a complaint investigation at the IMACA Elm Street Preschool and met with the Site Supervisor: Amanda Tatum . The purpose of the inspection was to inform the Site Superviosr that an investigation is being conducted regarding the above allegation: Facility did not report a Covid outbreak.
There are 14 childcare children present.
During the inspection, LPA interviewed teachers, operations coordinator, director an parents. Based on interviews with all parties involved and record review, the outdoor summer program did close early due to the illness. The interviews revealed inconsistencies in the explanations for the illness (Cold or Covid).
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the facility did not report a COVID-19 outbreak; therefore, the above allegation is Unsubstantiated.
Appeal Rights were provided and discussed with the Site Supervisor. No deficiencies were cited. Exit interview conducted and a copy of this report, notice of site inspection and appeal rights was given to the Site Supervisor Amanda Tatum.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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