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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197417593
Report Date: 05/20/2022
Date Signed: 05/20/2022 01:35:58 PM

Substantiated


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
04/04/2022 and conducted by Evaluator Justeene Tamayo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20220404150809
FACILITY NAME:KAI'S JUSTICE LEARNING ACADEMYFACILITY NUMBER:
197417593
ADMINISTRATOR:ADAMS, ALLEAFACILITY TYPE:
850
ADDRESS:2739 W. AVENUE LTELEPHONE:
(661) 718-3614
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:77CENSUS: 34DATE:
05/20/2022
UNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Adrienne Tolliver, DirectorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Plan of Operation: Facility staff did not provide transportation as necessary to meet child's needs.
INVESTIGATION FINDINGS:
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On 05/20/22, Licensing Program Analyst (LPAs) Justeene Tamayo and Barbara Beneroso met with director Adrienne Tolliver for the purpose of concluding an investigation concerning the above complaint allegation. Upon arrival LPA’s toured the facility and observed 34 children in care. Later during tour of the facility, LPA's met with Director Yessica Aparicio.

The investigation consisted of interviews with staff, children, and other complaint relevant parties including the review of supportive documentation. It was alleged that on multiple occasions, child #1 was not picked up from their school. Based on documentation reviewed, child #1 was picked up late on multiple occasions around October 2021 to April 14,2022. Although child #1 was not left unattended and waited in the office, this can pose a potential health and safety risk to children in care. During interviews with children and relevant parties it was disclosed other children were not picked up from their school in a timely manner.

Please see Complaint Investigation Report LIC9099C for additional information.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
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-20220404150809
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: KAI'S JUSTICE LEARNING ACADEMY
FACILITY NUMBER: 197417593
VISIT DATE: 05/20/2022
NARRATIVE
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Based on the information obtained, the above allegation is deemed Substantiated. A finding of substantiated means that allegation is valid. Facility has been cited a Type B citation Plan of Operation 101173(a)(b)(9). See LIC 9099D

An exit interview was conducted, and a copy of this report was read and provided to the Licensee on this date, along with a copy of her appeal rights.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20220404150809
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: KAI'S JUSTICE LEARNING ACADEMY
FACILITY NUMBER: 197417593
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2022
Section Cited
CCR
101173(a)(b)(9)
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Plan of Operation 101173(a)(b)(9): Each licensee shall have and keep on file a current written, definitive plan of operation….the plan…shall contain the following…transportation arrangements provided by the applicant/licensee for children who do not have independent arrangements.

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Per director Aparcio she will write a definitive plan on whether or not children need to be picked up and will send to LPA Tamayo and update Parent Handbook
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Based on observation and supportive documents, child #1 was not picked up from school in a timely manner on multiple occasions. This can pose a potential health and safety risk to 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: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3