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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197408260
Report Date: 07/23/2024
Date Signed: 07/25/2024 05:10:25 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 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
04/30/2024 and conducted by Evaluator Annelise Villa
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240430165117
FACILITY NAME:CROSSWIND COMMUNITY CHURCH-ADVENTURELAND INFANTFACILITY NUMBER:
197408260
ADMINISTRATOR:AMY CURTISFACILITY TYPE:
830
ADDRESS:41337 10TH STREET WESTTELEPHONE:
(661) 272-0681
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:16CENSUS: 4DATE:
07/23/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amy Curtis, DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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-Personal Rights - Staff do not ensure children are spoken to in an appropriate manner and do not ensure children are accorded with dignity and respect.
-Infant Safe Sleep - Infant was forced to take a nap and staff handled infant in a rough manner
-Personal Rights - Staff did not ensure care and supervision was provided to infant in care
-Reporting Requirements - Staff did not ensure reporting requirements were followed
INVESTIGATION FINDINGS:
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On July 25, 2024, LPA Villa amended this report to reflect allegations above. On July 23, 2024, Licensing Program Analysts (LPAs) Annelise Villa and Kris Diaz conducted a follow up complaint investigation related to the allegations above. LPAs disclosed the purpose of the investigation and was granted entry into the facility by Director Amy Curtis. A tour of the facility was completed and safety inspection conducted that yielded 0 deficiencies. LPAs verified a census of 4 infants and 4 staff working under the facility license. During today's investigation, LPA Villa interviewed complaint relevant parties and delivered findings. The investigation revealed staff have spoken to children using derrogatory nicknames and harsh language. Additionally, it was revealed children were forced to take naps and staff used inappropriate means to restrict children from leaving the nap area. Lastly, record review revealed an incident occured on 4/25/2024, wherein a child fainted and fell to the floor. No injury was sustained. The allegation was substantiated, however, no deficiency was cited as this incident falls under personal rights and a violation was cited. No unusual incident report was received. Based on LPAs observations, interviews conducted, and record reviews, the preponderance of the evidence has been met, therefore, the above allegations are found to be SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
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 3
Control Number 12-CC-20240430165117
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CROSSWIND COMMUNITY CHURCH-ADVENTURELAND INFANT
FACILITY NUMBER: 197408260
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
CCR
101430(a)(3)(B)
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Infant Safe Sleep 101430(a)(3)(B). No infant shall be forced to sleep, to stay awake or to stay in the designated sleeping area.

This requirement was not met as evidenced by:
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All staff shall participate in California Childcare Health Program training on Infant Safe Sleep and send proof of completion to LPA Villa no later than 7/26/2024.
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Based on interviews and record review, staff forced infants to take naps and staff used inappropriate means to restrict children from leaving the nap area by physical restriction, which poses a potential health, safety, and personal rights risk of children in care.
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Type B
07/26/2024
Section Cited
CCR
101223(a)(1)
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Personal Rights 101223(a)(1): The licensee shall ensure that each child is accorded... dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
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At the instruction of the Director, all staff shall participate in personal rights training and send proof of completion to LPA Villa no later than 7/26/2024.
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Based on evidence obtained, it was revealed Staff #2 spoke to children in an inappropriate manner using harsh language. Additionally, Staff #1 stated to LPAs a derogatory nickname had been used for a child, which poses a potential health, safety, and personal rights risk of children 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: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20240430165117
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CROSSWIND COMMUNITY CHURCH-ADVENTURELAND INFANT
FACILITY NUMBER: 197408260
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2024
Section Cited
CCR
101212(d)
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Reporting Requirements 101212(d) a report shall be made...within the Department's next working day and during its normal business hours. In addition, a written report ...shall be submitted to the Department within seven days following the occurrence of such event.
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At the instruction of the Director, all staff shall participate in personal rights training and send proof of completion to LPA Villa no later than 7/26/2024.
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This requirement was not met as evidenced by:

Based on record review and interviews, revealed an incident occured on 4/25/2024, wherein a child fainted and fell to the floor with no injury sustained. No unusual incident report was received, which poses a potential health, safety, and personal rights risk of children 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: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024
LIC9099 (FAS) - (06/04)
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