197416069-8-23-2021-12-CC-MRAN-C67QGL-20210824120940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197416069
Report Date: 08/23/2021
Date Signed: 08/23/2021 05:47:25 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
05/27/2021 and conducted by Evaluator Lady King

COMPLAINT CONTROL NUMBER: 12-CC-20210527152931

FACILITY NAME:	COTTAGE FAMILY CHILD CARE		FACILITY NUMBER:	197416069
ADMINISTRATOR:	COTTAGE, YVONNE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(661) 206-9049
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	14	CENSUS: 14	DATE:	08/23/2021
		UNANNOUNCED	TIME BEGAN:	05:20 PM
MET WITH:	Yvonne Cottage		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Care provider hit day care child.
Care provider inappropriately handled day care children.
Care provider poked day care children with an object.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Lady King-Lewis conducted a follow up complaint inspection for the purpose of concluding the investigation for the above allegations. Upon arrival, LPA met with licensee Yvonne Cottage . LPA observed 14 children with 2 staff members providing care and supervision. The investigation consisted of interviews with staff and other relevant parties.
Interviews conducted revealed that several of the daycare’s children attends the licensee’s husband Jiu Jitsu class. LPA was informed Jiu Jitsu is a type of martial art course that teaches self-discipline, self-control and fitness. The martial art course is taught on the same premises as the day care but not in the day care designated area of the home. LPA observed written consent forms from several daycare parents giving consent for children to participate in the martial art classes. LPA was also informed licensee’s grandchildren attends the daycare and licensee and husband does spend time with the grandchildren outside of the daycare.
The allegations of a day care provider hit day care child, day care provider inappropriately handled day care children, and day care provider poked day care children with an object were investigated. Based on the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

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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Control Number 12-CC-20210527152931

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: COTTAGE FAMILY CHILD CARE	FACILITY NUMBER: 197416069
	VISIT DATE: 08/23/2021

NARRATIVE

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information obtained during the interviews conducted, it was determined that the above allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted, a copy of this report, appeal rights, notice of site visit are discussed and was left with the Licensee.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021

LIC9099 (FAS) - (06/04)

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