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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403329
Report Date: 04/22/2024
Date Signed: 04/22/2024 02:58:59 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 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
01/30/2024 and conducted by Evaluator Annelise Villa
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240130130518
FACILITY NAME:CROSSWIND COMMUNITY CHURCH-ADVENTURELAND P.S.FACILITY NUMBER:
197403329
ADMINISTRATOR:AMY CURTISFACILITY TYPE:
850
ADDRESS:41337 10TH STREET WESTTELEPHONE:
(661) 272-4903
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:73CENSUS: 28DATE:
04/22/2024
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Amy Curtis, DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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- Neglect/lack of Supervision: Facility Staff did not prevent children in engaging in inappropriate altercations
-Personal Rights: Facility staff isolated child from other children
INVESTIGATION FINDINGS:
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On April 24, 2024, LPA Annelise Villa met with Director Amy Curtis for the purpose of concluding the investigation concerning the above allegations. The investigation consisted of interviews conducted with children, staff and other relevant complaint parties. LPA received documents related to this investigation which included the facility’s staff roster and children’s roster.

Through interviews conducted and observations, the investigation revealed the facility isolated a child during eating times. In addition to interviews with staff and complaint relevant parties, LPA observed the table the classroom facing the wall.

Additionally, record review revealed multiple incidents of biting the the classroom. Therefore, the above allegations are Substantiated. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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-20240130130518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CROSSWIND COMMUNITY CHURCH-ADVENTURELAND P.S.
FACILITY NUMBER: 197403329
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2024
Section Cited
CCR
101223(a)(1)
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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights:...To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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All staff shall ensure stating no child shall be required to sit isolated during group activites, including meal times. All staff shall participate in training on personal rights and send proof of completion to LPA Villa by 4/26/2024
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Through interviews LPA has concluded child #1 was not accorded dignity in their personal relationships with staff and other persons. Interviews confirmed Child #1 was repeatedly isolated from other daycare children during meal times.
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Type B
04/22/2024
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).This requirement is not met as evidenced by:
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All staff shall particiapte in training in Biting in the child care setting and send proof of completion to LPA Villa by 4/26/2024.
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Multiple incidents of biting among children in the classroom.
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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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2