197409136-4-13-2022-12-CC-MRAN-CDQNLP-20220422103349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197409136
Report Date: 04/13/2022
Date Signed: 04/13/2022 11:42:26 AM

Unsubstantiated

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
03/15/2022 and conducted by Evaluator Monique Jessica Ayala

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20220315142553

FACILITY NAME:	NOTRE DAME PRESCHOOL		FACILITY NUMBER:	197409136
ADMINISTRATOR:	ANGELICA M RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	21704 GOLDEN TRIANGLE RD.#120		TELEPHONE:	(661) 255-0053
CITY:	SAUGUS	STATE: CA	ZIP CODE:	91350
CAPACITY:	44	CENSUS: 33	DATE:	04/13/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Angelica Rodriguez, Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Ratio: Licensee is operating over ratio
Lack of supervision: Child hit his head on the floor and teacher did not know what happened

INVESTIGATION FINDINGS:

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On April 13, 2022 Licensing Program Analyst's (LPAs) Monique Ayala and Justeene Tamayo conducted a follow-up investigation to the facility. LPAs met with director who guided LPAs on a tour of the facility. The purpose of the inspection was to deliver the findings for the above complaint allegations. LPAs observed 33 children with 3 fully qualified staff.

The investigation consisted of interviews with staff, children, other relevant complaint parties and review if staff and children attendance sheets. The interviews and attendance sheets revealed that there were no witnesses/evidence that could corroborate that the facility is out of ratio, the day the child hit his head on the floor was observed by staff 1, per parent 1 there was an incident report provided. Based on the evidence obtained the above allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report along with Notice of Site Visit and appeal rights were provided to director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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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