364840739-3-5-2020-12-CC-MRAN-BNAV9H-20200402161421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 364840739
Report Date: 03/05/2020
Date Signed: 03/05/2020 03:27:54 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
01/10/2020 and conducted by Evaluator Jazelle Neal

PUBLIC

COMPLAINT CONTROL NUMBER: 12-CC-20200110094557

FACILITY NAME:	PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL		FACILITY NUMBER:	364840739
ADMINISTRATOR:	STEPHANIE RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	17251 DANTE STREET		TELEPHONE:	(760) 951-1425
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	32	CENSUS: 25	DATE:	03/05/2020
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Stephanie Hernandez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Allegation: Personal Rights - Day care children engaged in inappropriate behaviors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Neal met with Director, Stephanie Hernandez, for the purpose of a follow-up complaint inspection of the above allegation. During this investigation, LPA Neal interviewed staff, children, parents and other relevant complaint parties. Based on interviews conducted, it was determined that the level of children's behavior (hitting, kicking, scratching, verbal vulgarities) by children towards other children that has, at times, resulted in minor scratches has reached a level of violation of personal rights of children. Based on the information obtained, 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 in any incidents. 1 Type B deficiency was cited. Appeal Rights were given to be posted for 30 days. Notice of Site Visit was given to be posted for 30 days. Exit interview was conducted, report was read and a copy was given to the director.

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (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)

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Control Number 12-CC-20200110094557

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 101223(a)(1)	1 2 3 4 5 6 7	Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not	1 2 3 4 5 6 7	Director has taken actions to work with parents regarding children's behaviors. Referrals are pending, Children's schedules modified and training took place 2/5, 2/6 & 3/5 with staff. Cleared during inspection.
	8 9 10 11 12 13 14	met by: Staff failed to prevent children's hitting, kicking, scratching, throwing things towards other children has resulted in minor scratches of children in care which is a potential H&S risk.	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: Jazelle Neal	TELEPHONE: (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)

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