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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191201899
Report Date: 07/19/2023
Date Signed: 07/19/2023 10:41:14 AM

Unsubstantiated


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
06/05/2023 and conducted by Evaluator Justeene Tamayo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20230605135418
FACILITY NAME:LANCASTER UNITED METHODIST CHURCH PRE SCHOOLFACILITY NUMBER:
191201899
ADMINISTRATOR:MEDINA, NICOLEFACILITY TYPE:
850
ADDRESS:918 WEST AVENUE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:58CENSUS: 40DATE:
07/19/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nicole Medina,Director TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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9
Allegation:

Other-Facility is not complying with court order
INVESTIGATION FINDINGS:
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On 07/19/23 Licensing Program Analyst (LPA) Justeene Tamayo met with Director Nicole Medina for the purpose of concluding the investigation concerning the above allegation. A tour of the facility was conducted, a total of 4 classrooms were toured. LPA verified a census of 40 preschool children and a total of 7 Staff.

The investigation consisted of interviews with child #1, staff and other complaint relevant parties including the review of supportive documentation. Concerning the allegation of facility failed to follow court order, after interviews with the Director and Administrator, parent #1 asked for child #1 personal information via telephone. The Administrator explained to parent #1 that no personal information can be provided via telephone due to the safety of each child. After interviews with parent #1 and parent #2, the center followed the court order that was provided.

Please see LIC9099-C for Continuation Page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
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-20230605135418
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: LANCASTER UNITED METHODIST CHURCH PRE SCHOOL
FACILITY NUMBER: 191201899
VISIT DATE: 07/19/2023
NARRATIVE
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Based on the information provided, the above allegation is rendered unsubstantiated at this time. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegation occurred.

An exit interview was conducted, a copy of this report, appeal rights, and a notice of site visit report was provided to the facility.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2