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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191225626
Report Date: 03/28/2025
Date Signed: 03/28/2025 01:03:25 PM

Unsubstantiated


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
03/06/2025 and conducted by Evaluator Mayra Rivera
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20250306134924
FACILITY NAME:JOHNSON-POWELL FAMILY CHILD CAREFACILITY NUMBER:
191225626
ADMINISTRATOR:JOHNSON-POWELL, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 297-3274
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:14CENSUS: 4DATE:
03/28/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jacqueline Johnson-Powell, LicenseeTIME COMPLETED:
01:13 PM
ALLEGATION(S):
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Licensee does not ensure the home is kept orderly.
INVESTIGATION FINDINGS:
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On Friday, March 28, 2025, Licensing Program Analysts (LPAs), Mayra Rivera and Ana Rodriguez conducted an unannounced complaint inspection in regards the above allegation and met with Licensee Jacqueline Johnson- Powell and guided LPAs Rivera and Rodriguez on a tour of the facility. Upon LPAs Rivera and Rodriguez arrival, LPA Rivera observed 4 preschool children present and observed the facility to be within ratio.

During the course of this investigation, LPA Mayra Rivera, conducted confidential interviews with parents and inspected the facility. Based on the confidential interviews with parents, 3 parents stated they have no concerns with the quality of care provided, and their children are happy to attend the facility. One parent stated the concern is too many toys and not sure if the toys are being disinfected daily. Based on LPA Rivera inspection, LPA observed the facility to have lots of toys accessible to children. LPA Rivera observed the walking path to be clear of obstacles and easily accessible for walking. LPA Rivera did not observe hazard materials that may injure children or facility to have unpleasent smell.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 4
Control Number 12-CC-20250306134924
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: JOHNSON-POWELL FAMILY CHILD CARE
FACILITY NUMBER: 191225626
VISIT DATE: 03/28/2025
NARRATIVE
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LPA Rivera observed the bookshelves and entertainment center to be anchored to the wall. Based on the interviews and LPA observation, the evidence did not support nor confirm the allegation of licensee does not ensure the home is kept orderly.

This agency has investigated the complaint alleging Licensee does not ensure the home is kept orderly. At this time, it is determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore at this time the above allegation is unsubstantiated. No deficiency given at this time.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Jackie Johnson-Powell. The licensee was provided a copy of the appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4