197750052-10-21-2021-12-CC-SHEG-C8CSNX-20211101140216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197750052
Report Date: 10/21/2021
Date Signed: 10/21/2021 03:17:28 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
05/19/2021 and conducted by Evaluator Brigitte Tsutaoka

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20210519142330

FACILITY NAME:	IT'S A SMALL WORLD		FACILITY NUMBER:	197750052
ADMINISTRATOR:	CANCHOLA, ANTONIO&YESENIA		FACILITY TYPE:	830
ADDRESS:	44221 10TH ST WEST		TELEPHONE:	(661) 492-0550
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	39	CENSUS: 19	DATE:	10/21/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Director Yesenia Canchola		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Allegation 1: Day care child sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On October 21, 2021, at 2:10 PM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced follow up complaint inspection to deliver findings on the above allegation. LPA disclosed the purpose of inspection and was granted entry by Director. Licensee Yesenia Canchola arrived at 2:30PM and guided LPA on a tour of the facility. Upon entry, LPA counted 19 children and 3 staff.

On 05/18/2021 at approximately 8:00AM, Child 1 and Child 2 were sitting playing in circle time. Staff 1 addressed the children notifying them it was time to clean up. Child 2 was playing with two box cubes. Child 1 got up and ran over to Child 2 subsequently tackling her in an attempt to take the toys. Child 2 reacted by biting Child 1's right wrist, resulting in an injury. Staff 1 ran over to the children and Child 1 disclosed the injury hurt and displayed the injury on his arm. Staff 1 addressed the injury by applying ice, ointment, and a bandaid to keep the affected area clean.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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-20210519142330

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: IT'S A SMALL WORLD	FACILITY NUMBER: 197750052
	VISIT DATE: 10/21/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

It was determined during play time, Child 1 spontaneously tackled Child 2, and Child 2 responded by biting Child 1, resulting in a significant abrasion requiring medical attention. Staff reacted immediately and applied first aid to the affected area. Based on evidence obtained, records reviewed, and interviews conducted, the allegation is deemed Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations did or did not occur.

An exit interview was conducted, a copy of this Report and Notice of Site Visit were provided to Licensee.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte Tsutaoka	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2