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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197415591
Report Date: 11/05/2025
Date Signed: 11/05/2025 01:34:34 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
08/01/2025 and conducted by Evaluator Annelise Villa
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20250801152827
FACILITY NAME:POWELL FAMILY CHILD CAREFACILITY NUMBER:
197415591
ADMINISTRATOR:POWELL, ANTOINETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 802-6841
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 10DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Antoinette Powell, LicenseeTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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9
-Neglect/Lack of Supervision: Day care child sustained multiple burns on feet
-Personal Rights: Day care provider did not seek timely medical attention for child in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Annelise Villa conducted an unnanouced visit to deliver findings. LPA disclosed the purpose of the visit and was granted entry into the facility by Licensee Antoinette Powell. A tour of the facility was conducted. LPA verified a census of 10 children and 2 staff, including Licensee, working under the facility license. No deficiencies were observed during the tour.

The investigation was conducted by the Community Care Licensing Investigations Bureau, Investigator Rocio Flores. The investigation consisted of interviews with the licensee and other relevant parties. Allegation #1 states Child #1 sustained burns on their feet. Medical report stated the injuries could have come from rug burn or heat, however the cause of the injuries were unable to be determined. Licensee stated the injury did not happen at the facility and Parent #1 was advised immediately upon observation. During the investigation, the licensee’s statements to law enforcement, DCFS, and the IB investigator remained consistent.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 2
Control Number 12-CC-20250801152827
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: POWELL FAMILY CHILD CARE
FACILITY NUMBER: 197415591
VISIT DATE: 11/05/2025
NARRATIVE
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Allegation #2 states Licensee did not seek timely medical attention for child in care. Medical report obtained revealed the injury would have required immediate medical attention only if the infant had shown behavioral changes such as crying, pain, discomfort, or fussiness, or if there had been continuous bleeding, pus, or significant swelling. Both the Licensee and Assistant #1 reported the infant behaved normally and did not display any signs of pain or discomfort. Per Licensee, when she noticed Child #1's injuries, she administered first aid by applying ointment to the affected areas. In the absence of these symptoms, it was deemed appropriate to manage the injury at home using self-care measures, such as applying over-the-counter ointment.

Based on interviews with complaint relevant parties and record review, Allegation #1 and Allegation #2 are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted with Licensee. A copy of this report, appeal rights and Notice of Site Visit were left with Licensee.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2