364819494-5-26-2021-12-CC-MRAN-C3FRSB-20210528131626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364819494
Report Date: 05/25/2021
Date Signed: 05/26/2021 02:38:24 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
03/08/2021 and conducted by Evaluator Victoria Hunt

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20210308100657

FACILITY NAME:	KIDS DISCOVERY WORLD		FACILITY NUMBER:	364819494
ADMINISTRATOR:	SUSAN ACOSTA		FACILITY TYPE:	830
ADDRESS:	15858 BEAR VALLEY ROAD		TELEPHONE:	(760) 241-2416
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	12	CENSUS: 11	DATE:	05/25/2021
		UNANNOUNCED	TIME BEGAN:	04:22 PM
MET WITH:	Mal Fernando		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Allegation #1 Refrigerator and dishwasher leaking possible mold in facility

INVESTIGATION FINDINGS:

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Licensee Program Analyst (LPA) Victoria Hunt met with Director Malkanthi Fernando to deliver the finding into the above allegation. Interviews were conducted with staff, children, and other relevant parties to the investigation. Photographs were obtained of the refrigerator and a underneath a cabinet sink.

The investigation revealed that sometime in 2019, there was a leak of a refrigerator within the facility which resulted in a significant amount of water penetrating the floor and the adjacent wall. It's undetermined how long the refrigerator had been leaking although the refrigerator had been replaced by the facility. There was also a disclosure that dishwasher was observed to be leaking in the facility. Photographs depict a significant amount of water which penetrated into the walls and floors.
Based on the evidence gathered there is sufficient evidence to prove the allegation occurred; therefore, the allegation is deemed to be substantiated. An exit interview was conducted with the director and a copy of this report was discussed and appeal rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 12-CC-20210308100657

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: KIDS DISCOVERY WORLD	FACILITY NUMBER: 364819494
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/25/2021 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	Buildings and Grounds The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met as evidenced by: sometime in 2019, there was a leak of a refrigerator within the facility which resulted in a	1 2 3 4 5 6 7	Although, the refrigerator has been replaced, the it is recommended that a mold analysis for the facility be conducted to ensure that there is no risk to children in care and a copy provided to CCLD by the Plan of Correction due date of 06/25/21.
	8 9 10 11 12 13 14	significant amount of water penetrating the floor and the adjacent wall. It's undetermined how long the refrigerator had been leaking although the refrigerator had been replaced with the facility. Also a dishwasher was observed to be leaking at the facility,	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: Victoria Hunt	TELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021

LIC9099 (FAS) - (06/04)

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