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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197417594
Report Date: 07/07/2021
Date Signed: 07/08/2021 11:27:45 AM



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
06/24/2021 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20210624140803
FACILITY NAME:KAI'S JUSTICE LEARNING ACADEMYFACILITY NUMBER:
197417594
ADMINISTRATOR:ADAMS, ALLEAFACILITY TYPE:
840
ADDRESS:2739 W. AVENUE LTELEPHONE:
(661) 718-3614
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:43CENSUS: 16DATE:
07/07/2021
UNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Karen ErroaTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Allegation: Physical Plant
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Ortega and Ayala met with Director for the purpose of conducting a follow-up complaint investigation for the above allegation. LPAs Ortega and Ayala toured the Facility and a total of 16 school age children and 2 staff were present today.

Allegations: Physical Plant- During this investigation, LPAs observed paint chipped and peeled around the boarder and walls including the side front entrance to the school age room. Based on observation obtained the allegation of Physical plant is deemed SUBSTANTIATED and a citation will be issued(See LIC 9099-D for cited deficiency). A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met. This facility was cited a Type B in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes.

Copy of this report, notice of site visit was provided to Director Karen Erroa.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
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 2
Control Number 12-CC-20210624140803
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: KAI'S JUSTICE LEARNING ACADEMY
FACILITY NUMBER: 197417594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2021
Section Cited
CCR
101238
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(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met by evidenced by :LPAs obsevation.
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Facility stated paint will be repaired and maintained by 7/23/2021. Pictures of repair will be submitted via email or text to the Palmdale Regional office and LPA Ortega.
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LPA's obsevation. LPA's observed paint chip in the school age room on multipal areas in the room and at the enterance by the front desk. Based on LPA's observation, facility did not ensure a good environment repair which poses a potential risk to the health and safety of children in care.
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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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2