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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197408073
Report Date: 05/21/2021
Date Signed: 05/21/2021 03:16:54 PM



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
04/28/2021 and conducted by Evaluator Victoria Hunt
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210428121518
FACILITY NAME:LANDERS FAMILY CHILD CAREFACILITY NUMBER:
197408073
ADMINISTRATOR:LANDERS, KARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 618-1333
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 8DATE:
05/21/2021
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Karlene Landers TIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Personal Rights - Child injured while playing on play equipment.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Victoria Hunt met with the licensee, Karlene Landers for the purposes of concluding the complaint investigation into the above allegation. Due to COVID-19 Emergency Response the delivery of the report findings was conducted virtually. The investigation consisted of interviews with the licensee, day-care children, and other relevant parties to the investigation. A review of child #1 records was conducted, medical reports, and photographs were obtained for this investigation. The following was revealed:

On 04/28/21 child #1, was playing on a slide that was stationed outside in the backyard, on a slab of concrete. Child #1 fell from the slide which resulted in the child sustaining an injury to the right wrist and arm requiring medical attention. Through corroborating statements, witnesses observed child #1, playing on the slide then falling. At the time of the incident witnesses observed the licensee being a few steps away from child #1. Child #1, was assessed for injury by the licensee and aid was administered prior to the parent being notified.

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Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
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-20210428121518
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: LANDERS FAMILY CHILD CARE
FACILITY NUMBER: 197408073
VISIT DATE: 05/21/2021
NARRATIVE
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************* 05/21/21 Report Amended to correct error on report **********
Based on the evidence obtained during the investigation no lack of supervision occurred and it does appear that this incident was an isolated. Overall, this facility has no history of incidents of this nature. Therefore, this complaint investigation was deemed substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met.

Type B deficiency is being cited. A Type B deficiency is being cited because potential safety risk occurred. Although child was being supervised by licensee, child #1 on the play equipment that was not appropriate to the child's age based on manufacturers guidance; therefore a deficiency is being cited.

An exit interview was conducted, and this report was read and discussed with the licensee. Appeal Rights were also provided to the licensee Karlene Landers. This report is being sent electronically, with delivery confirmation receipt as signature confirmation. A Notice of Site Visit provided, and licensee was advised to post for 30 days.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20210428121518
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: LANDERS FAMILY CHILD CARE
FACILITY NUMBER: 197408073
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2021
Section Cited
CCR
102423(a)(2)
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Personal Right
Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee .....These rights include, but are not limited to, the following: To receive safe, healthful, and comfortable accommodations, furnishings, and

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The licensee has removed the play equipment from the premises of the facility. Licensee will ensure that children was play on equipment that is age appropriate and adhere to manufacturer guidance and recommendations.
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equipment. This requirement was not met as evidenced by.
04/28/21 child #1, was playing on a slide that was stationed outside in the backyard, on a slab of concrete. Child #1 fell from the slide which resulted in the child sustaining an injury to the right wrist and arm; requiring medical attention.
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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: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3