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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700191
Report Date: 07/06/2021
Date Signed: 07/06/2021 05:17:08 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
07/01/2021 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20210701103130
FACILITY NAME:DUNN, RODEEN FAMILY CHILD CAREFACILITY NUMBER:
197700191
ADMINISTRATOR:DUNN, RODEENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 878-6794
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 13DATE:
07/06/2021
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Dunn RodeenTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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One Staff meember tested positive for Covid-19
Licensee did not report the Covid-19 positive Exposure
INVESTIGATION FINDINGS:
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On July 6,2021 at 1:35 PM, Licensing Program Analyst (LPA) Carol Heath initiated a complaint investigation at the Dunn Rodeen Family Child Care Home and met with the Licensee. The purpose of the inspection was to inform the Licensee that an investigation is being conducted regarding the above allegation: One Staff member test positive for Covid-19 and Licensee did not report the Covid-19 Positive exposure. On 7/6/2021, LPA Heath conducted interviews with Licensee and 2 assistants (See Confidential Names form LIC 811) . According to the Licensee, her staff #1 reported to her 6/22 (Tuesday) with a Covid-19 positive test result . The facility closeed 6/23 and 6/24. The Facility reopen on 6/25 to the staff and family with negative result. According to Licensee, she closed her facility on 7/2/2021 (Last Friday).

Based on LPA interviews, it was determined that the licensee failed to report CCLD about the COVID-19 positive exposure. The licensee did not notify the Department by telephone or in writing within the mandated timeframe. There is a preponderance of the evidence to prove that the licensee failed to meet the reporting requirements. Therefore, the above allegation is found to be SUBSTANTIATED.






Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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 3
Control Number 12-CC-20210701103130
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: DUNN, RODEEN FAMILY CHILD CARE
FACILITY NUMBER: 197700191
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2021
Section Cited
CCR
102416.2(d)(1)
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Reporting Requirements: 102416.2(d)(1)
A report shall be made to the department by telephone or fax during the department's
normal business hours before the close of the next working day following the occurrence during the operation of family day care home of…the…events."
This requirement is not met as evidenced by:
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The licensee will fax (661-202-3810) her UIR or any documentation to the Palmdale Regional office. The Licensee will text LPA to comfirm the RO receive the paperwork.
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Based on observation, interviews and record
review, the licensee did not report to Palmdale
Regional Office about this Covid-19 positive exposure which poses a potential Health, Safety risk to people 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: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 12-CC-20210701103130
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: DUNN, RODEEN FAMILY CHILD CARE
FACILITY NUMBER: 197700191
VISIT DATE: 07/06/2021
NARRATIVE
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During the investigation, LPA informed the licensee to submit a current copy of the children’s roster.

Appeal Rights were provided and discussed with the Licensee and Type B deficiencies was cited.

Exit interview conducted and a copy of the report and Notice of Site Visit was left with the Licensee.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3