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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364840739
Report Date: 03/05/2020
Date Signed: 03/05/2020 03:25:12 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
12/16/2019 and conducted by Evaluator Jazelle Neal
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20191216101455
FACILITY NAME:PSD/NORTHGATE HEAD STAR/STATE PRESCHOOLFACILITY NUMBER:
364840739
ADMINISTRATOR:SHAWANDA CHEATHAMFACILITY TYPE:
850
ADDRESS:17251 DANTE STREETTELEPHONE:
(760) 951-1425
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:32CENSUS: 25DATE:
03/05/2020
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Stephanie HernandezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Allegation #1: Lack of Supervision - Lack of supervision resulting in child being bit by another child in care.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Neal met with Director, Stephanie Hernandez, for the purpose of a follow-up complaint inspection of the above allegations. Upon arrival, 25 children and 3 teachers were observed during playtime. During this investigation, LPA Neal interviewed staff, children, parents and other relevant complaint parties, as well as reviewed files and incident reports. Per staff admittance, it was determined that Child #1 was bitten by Child #2 on at least 3 separate occasions. Because staff failed to prevent the additional incidents from occurring in a pattern which resulted in child #1 sustaining superficial bite marks, the allegation is deemed substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Medical attention was not needed.
1 Type B deficiency was cited. Appeal Rights were given. Notice of Site Visit was given to be posted for 30 days.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
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
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
12/16/2019 and conducted by Evaluator Jazelle Neal
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20191216101455

FACILITY NAME:PSD/NORTHGATE HEAD STAR/STATE PRESCHOOLFACILITY NUMBER:
364840739
ADMINISTRATOR:SHAWANDA CHEATHAMFACILITY TYPE:
850
ADDRESS:17251 DANTE STREETTELEPHONE:
(760) 951-1425
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:32CENSUS: 25DATE:
03/05/2020
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Stephanie HernandezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Allegation #2: Personal Rights - Staff failed to ensure day-care children were clothed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Neal met with Director Stephanie Hernandez, for the purpose of a follow-up complaint inspection of the above allegations. During this investigation, LPA Neal interviewed staff, children, parents and other relevant complaint parties, as well as reviewed files. It was determined that Child #3 and Child #4 took off their own clothes while in the classroom during nap time. Per statements, harm was not expressed during this incident and children were re-clothed. Inconsistent statements were given as to the number of clothing items that were removed. As far as staff failing to ensure children were clothed, the information obtained revealed that there were 3 staff members present. Child #1 was with Staff #1, while Child #2 was with Staff #2. Per statements, incident occurred very quickly and staff took actions to guide children to redress themselves without violating their personal rights. Complaint is therefore unsubstantiated.
Exit interview was conducted, report was read and a copy given to the director.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20191216101455
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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2020
Section Cited
CCR
101229(a)
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Responsibility for Providing Care and Supervision - The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met by: Staff failed to prevent
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Training took place 2/5, 2/6 and 3/5/2020 with staff. Cleared during inspection.
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14
pattern of Child #1 bitting Child #2 on at least 3 separate occasions which resulted in superficial bite marks which is a potential health and safety risk.
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14
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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) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3