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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 150405677
Report Date: 08/27/2019
Date Signed: 08/27/2019 11:43:01 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/11/2019 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20190611141125
FACILITY NAME:LION'S DAY CARE / PRESCHOOLFACILITY NUMBER:
150405677
ADMINISTRATOR:SIMON, DEBORAFACILITY TYPE:
850
ADDRESS:3012 MT. PINOS WAYTELEPHONE:
(661) 245-1139
CITY:FRAZIER PARKSTATE: CAZIP CODE:
93225
CAPACITY:28CENSUS: 17DATE:
08/27/2019
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Debora SimonTIME COMPLETED:
11:56 AM
ALLEGATION(S):
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9
Personal Rights:
Licensee used inappropriate form of discipline on day care child
INVESTIGATION FINDINGS:
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On 8/27/2019 at 10:16 A.M., Licensing Program Analysts (LPAs), Isabel Ortega and Jesse Sims arrived at the above facility for the purpose of conducting a complaint investigation related to the above allegation. LPAs disclosed the purpose of the visit and were granted entry into the facility. Upon arrival LPAs observed 17 children in care.

During the course of the investigation, LPA Ortega obtained copies of files, conducted interviews with children, staff members, and parents. After conducting interviews and reviewing all pertinent information related to the complaint, LPA was unable to obtain consistent information regarding the allegation. Based on interviews conducted it was determined there were no witnesses or reports of staff having used any inappropriate form of discipline on day care child.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
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 2
Control Number 12-CC-20190611141125
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: LION'S DAY CARE / PRESCHOOL
FACILITY NUMBER: 150405677
VISIT DATE: 08/27/2019
NARRATIVE
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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the aforementioned allegation is unsubstantiated.
An exit interview was conducted, a copy of this report, notice of site visit, and appeal rights were provided to Director, Debora Simon.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2