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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153808406
Report Date: 07/01/2024
Date Signed: 07/01/2024 04:22:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 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
04/29/2024 and conducted by Evaluator Crystal Ali
COMPLAINT CONTROL NUMBER: 12-CC-20240429120225
FACILITY NAME:IMMANUEL CHRISTIAN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
153808406
ADMINISTRATOR:RAJARATNAM, RATNA P.FACILITY TYPE:
840
ADDRESS:1201 N. CHINA LAKE BLVD.TELEPHONE:
(760) 446-4505
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:50CENSUS: 26DATE:
07/01/2024
UNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Dr. Ratna Rajaratnam, DirectorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Allegation #3: Staff did not report incident to CCL.
INVESTIGATION FINDINGS:
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On 07/01/24 Licensing Program Analyst (LPA) Crystal Ali met with the facility Director to deliver the findings on the investigation into the above allegation.

Upon arrival, LPA observed 26 children in care present and 2 staff.

The investigation was conducted by the Community Care Licensing Investigations Bureau, Investigator Ruben Munoz and LPA Crystal Ali. The investigation consisted of interviews with the licensee, children, and other relevant parties. The investigation revealed consistent statements with allegation #3 staff did not report incident to CCL. The director admitted during the interview that the facility did not report this incident to CCL. Director informed LPA Ali, that the previous LPA stated to only report major incidents that include where the facility have to call ambulance or facility call the parent to take the child to the hospital.

Therefore, the allegations have been found substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
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 2
Control Number 12-CC-20240429120225
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMMANUEL CHRISTIAN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 153808406
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2024
Section Cited
CCR
101212(d)(1)
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Events reported shall include..: Death of any child..., injury to any child..., unusual incident or child absence ..threatens the physical or emotional health..., suspected physical or psychological abuse.., epidemic outbreaks, poisonings, ... fires or explosions that occur....
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All staff will be retrain on incident reporting in reference to CCL requirements. Licensee will provide proof of training to LPA via email. Licensee will provide their internal procedures on reporting incidents to their management and CCL.
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Based on observation, interviews and record
reviews the licensee did not ensure the injury was reported to CCL, which poses an immediate risk to the health safety and personal rights of the clients 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: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2024
LIC9099 (FAS) - (06/04)
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