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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418002
Report Date: 01/06/2020
Date Signed: 01/06/2020 12:03:50 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/30/2019 and conducted by Evaluator Jazelle Neal
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20191230101708
FACILITY NAME:VILLALOBOS FAMILY CHILD CAREFACILITY NUMBER:
197418002
ADMINISTRATOR:VILLALOBOS, ANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 533-3304
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 2DATE:
01/06/2020
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Ana VillalobosTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Personal Rights: Licensee cut daycare child’s hair without consent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Neal met with licensee, Ana Villalobos, for the purpose of notifying of the above complaint allegation. During this investigation, LPA reviewed licensee's text messages with approval, and interviewed relevant complaint parties. Based on licensee's admittance, a small portion of Child #1's hair was cut by licensee without obtaining consent from parent/guardian, therefore this complaint is substantiated. LPA observed that scissors used were a pair children's scissors with curved edges.
A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.
1 Type B deficiency was cited. See LIC9099D for details. Appeals Rights were given.
Notice of Site visit was given to be posted for 30 days.
Exit interview was conducted, report was read and a copy was given to licensee.
Substantiated
Estimated Days of Completion: 30
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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-20191230101708
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: VILLALOBOS FAMILY CHILD CARE
FACILITY NUMBER: 197418002
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2020
Section Cited
CCR
102423(a)(1)
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Personal Rights:Each child receiving services from a family child care home shall have certain rights that shall not be waived...These rights include, but are not limited to, the following: To be treated with dignity
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Licensee submitted a declaration regarding understanding of personal rights of children in care and notifying parents/guardians of circumstances pertaining to children in care.
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in his/her personal relationship with staff and other persons. This requirement was not met by licensee cuting Child #1's hair without consent which is a potential health and safety risk.
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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: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
LIC9099 (FAS) - (06/04)
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