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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197493026
Report Date: 10/21/2019
Date Signed: 10/21/2019 04:54:23 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
08/12/2019 and conducted by Evaluator Lady King
COMPLAINT CONTROL NUMBER: 12-CC-20190812165118
FACILITY NAME:KIDS AND KRAYONS LEARNING CENTERFACILITY NUMBER:
197493026
ADMINISTRATOR:CUEVAS, MARIAFACILITY TYPE:
850
ADDRESS:43137 VENTURE STREET #101TELEPHONE:
(661) 839-5252
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:45CENSUS: DATE:
10/21/2019
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Maria CuevasTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Personal Rights-Staff grabbed child’s hand resulting in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) King met with, Director Maria Cuvas today for the purpose of concluding the complaint investigation for the above allegation. Investigation consisted of interviews with, staff, parents, alleged victim, and children. Interviews conducted revealed child was not following staff instructions. Staff grabbed child by the hand to place child on time out when child pulled away. Staff grabbed child’s hand again and returned child to the chair (time out). The same incident re-occurred a third time. Based on the evidence obtained, the Department has determined that staff failed to appropriately redirect child, resulting in the child’s swollen hand and a minor scratch on child wrist.

This is a Type A violation. The licensee/Director was advised that a copy of the licensing report (LIC9099) and the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty

In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
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 3
Control Number 12-CC-20190812165118
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: KIDS AND KRAYONS LEARNING CENTER
FACILITY NUMBER: 197493026
VISIT DATE: 10/21/2019
NARRATIVE
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shall receive a copy of report and parents shall sign the LIC 9224 acknowledging receipt of licensing report.
Civil Penalty assessments will be assessed if all above requirements are not adhered too.

An exit interview was conducted, and a copy of this report was given to the Director.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20190812165118
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: KIDS AND KRAYONS LEARNING CENTER
FACILITY NUMBER: 197493026
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2019
Section Cited
CCR
101223(a)(1)
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Personal Rights
To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidence by: staff grabbed child’s hand three times to place child on time out and as a result child
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sustained a minor scratch on the wrist and the hand was slightly swollen. This is a Type A deficient which poses an immediate health and safety 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) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3