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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360900458
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:21:43 PM

Substantiated


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
12/11/2023 and conducted by Evaluator Babatunde Ibitoye
COMPLAINT CONTROL NUMBER: 12-CC-20231211121058
FACILITY NAME:HESPERIA COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
360900458
ADMINISTRATOR:JACQUELYN MANSFIELDFACILITY TYPE:
850
ADDRESS:16775 OLIVE STREETTELEPHONE:
(760) 244-6164
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:67CENSUS: 42DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jacquelyn MansfieldTIME COMPLETED:
03:47 PM
ALLEGATION(S):
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Personal Right/Admission Agreement
INVESTIGATION FINDINGS:
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On 02/27/2024, Licensing Program Analyst (LPA) Babatunde Ibitoye conducted an unannounced follow-up complaint inspection LPA met with the Director Jacquelyn Mansfied. The purpose of the inspection was to deliver the complaint finding for the above complaint allegations.
During today’s visit, LPA observed 42 childcare children in care, present with 8 Teachers.
During the course of the investigation of this complaint, LPA conducted interviews with all parties involved. LPA obtained the facility's children's roster and reviewed the C1 file.
Based on the evidence obtained it was revealed that the facility did not follow terms and conditions set forth in the admission agreement,the facility staff released C1 to an unauthorized minor without verifying their identification or obtaining prior parental authorization. Therefore, the preponderance of the evidence has been met and the allegation has been substantiated. see Lic 9099D.Tybe A Deficiency Cited.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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-20231211121058
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/29/2024
Section Cited
CCR
101219(d)
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Admission Agreement (d) Modifications to the original admission agreement shall be made whenever circumstances covered in the agreement change and shall be dated and signed by the persons specified in (c) above
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The facility will email a plan of correction by due date.
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This requirement was not met as evidenced by: Based on interview and record review, the facility staff released C1 to unauthorized minor without verifying their identification or obtaining prior parental authorization This posed 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
12/11/2023 and conducted by Evaluator Babatunde Ibitoye
COMPLAINT CONTROL NUMBER: 12-CC-20231211121058

FACILITY NAME:HESPERIA COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
360900458
ADMINISTRATOR:JACQUELYN MANSFIELDFACILITY TYPE:
850
ADDRESS:16775 OLIVE STREETTELEPHONE:
(760) 244-6164
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:67CENSUS: 42DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jacquelyn MansfieldTIME COMPLETED:
03:47 PM
ALLEGATION(S):
1
2
3
4
5
6
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8
9
Qualifications
INVESTIGATION FINDINGS:
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On 02/27/2024, Licensing Program Analyst (LPA) Babatunde Ibitoye conducted an unannounced follow-up complaint inspection LPA met with the Director Jacquelyn Mansfied.The purpose of the inspection was to deliver the complaint finding for the above complaint allegations.
During today’s visit, LPA observed 42 childcare children in care, present with 8 Teachers.During the course of the investigation of this complaint, LPA conducted interviews with all parties involved. LPA obtained the facility's children's roster and reviewed staff record.

Based on evidence obtained, the interviews and the documents reviewed revealed conflicting statements regarding the allegation that the facility do not meet pediatric CPR training requirements. Currently, there is no preponderance of evidence to prove the allegation. Therefore, based on the information obtained, the department finds the above allegation is deemed unsubstantiated.
An exit interview was conducted, and a copy of this report was provided to the Director Jacquelyn Mansfied along with a Notice of Site Visit and Appeal Rights.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 12-CC-20231211121058
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 02/27/2024
NARRATIVE
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Also, LPA informed the director to provide a copy of this licensing report dated (02/27/2024) 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 statements, must be placed in the child's file for verification.
An exit interview was conducted, and a copy of this report was provided to the Director Jacquelyn Mansfield along with a Notice of Site Visit and Appeal Rights.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4