197419412-12-30-2021-12-CC-MRAN-CASRHZ-20220118120309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197419412
Report Date: 12/30/2021
Date Signed: 12/30/2021 12:43:21 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
12/02/2021 and conducted by Evaluator Lady King

COMPLAINT CONTROL NUMBER: 12-CC-20211202154511

FACILITY NAME:	KAI'S JUSTICE CHILDCARE CENTER		FACILITY NUMBER:	197419412
ADMINISTRATOR:	JONES, AKEMIE		FACILITY TYPE:	840
ADDRESS:	2307 E. PALMDALE BLVD.		TELEPHONE:	(661) 947-5247
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93550
CAPACITY:	54	CENSUS: 0	DATE:	12/30/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Allea Adams, Licensee		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Personal Rights: Staff #1 handled child #1 in a rough manner resulting in redness on child #1’s arms

Reporting Requirement: Facility did not report timely an unusual incident that threatened the physical or emotional health or safety of child to the department.

INVESTIGATION FINDINGS:

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On December 30, 2021 Licensing Program Analyst (LPA) Lady King-Lewis conducted a subsequent complaint investigation inspection to deliver the findings of the above allegations. LPA met with licensee Allea Adams at the Lancaster facility. Upon arrival LPA did not observe any children in care, due to the facility being closed for the holidays.

The investigation consisted of interviews with staff, licensee, children and other complaint relevant parties. The investigation revealed that on 11-23-2021, child #1 was running around not following directions. Staff #1 grabbed child #1 by the arms and leaned child #1’s back against the table resulting in redness on child #1’s arms. This a violation of children's personal rights. Children are to be accorded with dignity in his or her personal relationships with staff and other persons. LPA King-Lewis reviewed the Unusual Incident Report database and determined an incident report was not submitted to the department on a timely manner.

This report is continued on LIC 9099-C

Substantiated

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: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

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 4

Control Number 12-CC-20211202154511

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 CHILDCARE CENTER	FACILITY NUMBER: 197419412
	VISIT DATE: 12/30/2021

NARRATIVE

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This report is continued from LIC 9099

Based on LPA's observations, interviews conducted, and record review, the preponderance of evidence standard has been met, therefore the above allegations are substantiated per California Code of Regulations, Title 22, Division 12 Chapter 1 section code 101223(a)(3) Personal Rights is a Type A violation and Section code 101212 (d) Reporting Requirements is a Type B violation.

See LIC 9099 D for deficiencies cited.

LPA King-Lewis informed licensee Allea Adams that this report dated 12-30-21 document 1 Type A citation, Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA King-Lewis informed the licensee Allea Adams to provide a copy of this licensing report dated 12-30-21 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted and a copy of this report, Appeal Rights, was provided to Licensee Allea Adams. A Notice of Site Visit was posted and must remain posted for 30 days. Removal of posting is subject to a $100 civil penalty.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 12-CC-20211202154511

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 CHILDCARE CENTER	FACILITY NUMBER: 197419412
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/31/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or	1 2 3 4 5 6 7	Due to this incident staff #1 was terminated. Furthermore, Licensee will scheduled all staff training concerning how to treat children to be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other
	8 9 10 11 12 13 14	toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidence by on 11-23-21 Staff #1 handled child #1 in a rough manner resulting in redness on child #1’s arms. This is a type A deficiency, that if not corrected, it poses an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14	actions of a punitive nature. Licensee will submit copies of the training agenda along with the training attendance sheet sign by all staff members that participated in the training session to the department no later than 01/13/12.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 12-CC-20211202154511

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 CHILDCARE CENTER	FACILITY NUMBER: 197419412
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/30/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/13/2022 Section Cited CCR 101212(d)	1 2 3 4 5 6 7	Reporting Requirements: Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business	1 2 3 4 5 6 7	Licensee will submit a written statement concerning her understanding on the Reporting Requirements Regulation no later than 01/13/22.
	8 9 10 11 12 13 14	hours... (1) Events reported shall include the following: C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidence by an unusual incident report concerning the incident that occurred on 11-23-21 was not reported on a timely manner. This is a type B deficiency, that if not corrected, it poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

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