153808406-1-3-2020-12-CC-CYAS-BKLUYQ-20200107150019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 153808406
Report Date: 01/03/2020
Date Signed: 01/03/2020 03:52:22 PM

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
10/28/2019 and conducted by Evaluator Jacky San

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20191028104845

FACILITY NAME:	IMMANUEL CHRISTIAN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	153808406
ADMINISTRATOR:	RAJARATNAM, RATNA P.		FACILITY TYPE:	840
ADDRESS:	1201 N. CHINA LAKE BLVD.		TELEPHONE:	(760) 446-4505
CITY:	RIDGECREST	STATE: CA	ZIP CODE:	93555
CAPACITY:	50	CENSUS: 16	DATE:	01/03/2020
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Veronica Sylva - Site Supervisor		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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9

Staff failed to report an incident to the authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jacky San conducted a follow-up complaint at Immanuel Christian Child Development and met with Site Supervisor, Veronica Sylva on 01/03/2019. The purpose of the inspection was to deliver the findings for the above allegations. Staff failed to notify child's authorized representative of incident while in care. Upon arrived LPA observed 11 school-age children, site supervisor and 13 staff member.

Based on interviews and physical evidence, it was determined Staff failed to notify child's authorized representative of incident while in care.

Based on the information obtained, there is a preponderance of the evidence to prove the above allegations; therefore, the above allegations is rendered substantiated. Copy of this report, Notice of Site Visit and Appeal Rights were discussed and provided with the Site Supervisor, Veronica Sylva and deficiencies were cited.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Jacky San	TELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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-20191028104845

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: IMMANUEL CHRISTIAN CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 153808406
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/10/2020 Section Cited CCR 101212(f)	1 2 3 4 5 6 7	101212(f) Reporting Requirements, (f) The items specified in (d)(1)(A) through (H) above shall also be reported to the child's authorized representative. This requirements does not meet as evidenced by:	1 2 3 4 5 6 7	Site Supervisor ensure to speak with director to provided training and make sure all staff report unusual incident to the authorized representative. Site Supervisor indicated that she will send in attendance when training is establish.
	8 9 10 11 12 13 14	Based off observation/interview/record review, the licensee did not ensure to report unusual incident to the child authorized representative; therefore, poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Jacky San	TELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
10/28/2019 and conducted by Evaluator Jacky San

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20191028104845

FACILITY NAME:	IMMANUEL CHRISTIAN CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	153808406
ADMINISTRATOR:	RAJARATNAM, RATNA P.		FACILITY TYPE:	840
ADDRESS:	1201 N. CHINA LAKE BLVD.		TELEPHONE:	(760) 446-4505
CITY:	RIDGECREST	STATE: CA	ZIP CODE:	93555
CAPACITY:	50	CENSUS: 16	DATE:	01/03/2020
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Veronica Sylva - Site Supervisor		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

1
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3
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5
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7
8
9

Staff inappropriately disciplines daycare children.
Staff are yelling at the daycare children.

INVESTIGATION FINDINGS:

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2
3
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5
6
7
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9
10
11
12
13

Licensing Program Analyst (LPA) Jacky San conducted an unannounced complaint inspection for the purpose of delivering finding for the above allegation. Upon arrived LPA observed 11 school-age children, site supervisor and 11 staff member. Based on interviews conducted with staff and LPA's observation the above allegation is Unsubstantiated. There is not enough evidence or witnesses to substantiate, therefore, allegation is rendered Unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegation occurred. At this time LPA unable to make determination that any violation occurred. Exit interview conducted and a copy of report was read and provided to Site Supervisor, Veronica Sylva.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Jacky San	TELEPHONE: (661) 305-3690
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3