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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419242
Report Date: 11/12/2021
Date Signed: 11/12/2021 03:33:51 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
08/25/2021 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20210825094648
FACILITY NAME:CREATIVE YEARS NURSERY SCHOOLFACILITY NUMBER:
197419242
ADMINISTRATOR:DENISE BAYLISFACILITY TYPE:
830
ADDRESS:21710 GOLDEN TRIANLE ROADTELEPHONE:
(661) 254-0718
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY:18CENSUS: 5DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Denise BaylisTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility is not enforcing the use of masks.
INVESTIGATION FINDINGS:
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On November 12, 2021 Licensing Program Analyst (LPA) Lady King-Lewis conducted a subsequent complaint investigation to deliver the findings of the above allegation. LPA met with the licensee and director, who guided LPA on a tour of the facility. Upon arrival LPA observed 5 infants in care with 2 staff.

The investigation of the above allegation consisted of staff interviews and LPA’s observations. On 08/30/21, LPA observed children in care not wearing facial mask. During interviews conducted, Licensee admitted that children over the age of 2 years old do not wear facial mask. LPA was informed staff are required to wear facial mask; however, children are not encouraged to wear facial mask. LPA was also informed the facility did not have a supply of children’s facial masks readily available for children in care.

Based on the evidence obtained, the above allegation is substantiated. The facility was cited a type B deficiency, see Complaint Investigation Report LIC9099D for citation.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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-20210825094648
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: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197419242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2021
Section Cited
CCR
101223(a)(2)
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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidence by
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As of 08-31-21, facility is now encouraging children over the age of 2 to wear facial mask. Furthermore, the facility has personal protection equipment (PPE) for children and staff when needed.
POC is cleared.

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on August 30, 2021, during the complaint investigation inspection, interviews conducted, LPA’s observation and documents provided from the facility, there is sufficient to substantiate the above allegation that facility is not enforcing children to wear face mask. This is a type B deficiency which poses a potential Health, Safety or Personal Rights risk to 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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
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