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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197418889
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:02:13 PM

Unsubstantiated


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
10/30/2023 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20231030095807
FACILITY NAME:GRIJALVA FAMILY CHILD CAREFACILITY NUMBER:
197418889
ADMINISTRATOR:GRIJALVA, AIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 396-2746
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY:14CENSUS: 6DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Aida GrijalvaTIME COMPLETED:
04:09 PM
ALLEGATION(S):
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Licensee did not provide the landlord form LIC 9149 to sign and give consent to run a day care
INVESTIGATION FINDINGS:
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On November 2, 2023 LPA Isabel Ortega conducted an unannounced complaint investigation to investigate the allegation above. LPA Ortega announced the purpose of inspection and was granted entry by licensee. Upon entry LPA observed six children in care and two Assistants fingerprint cleared and associated providing care and supervision.
It was alleged Licensee did not provide written notice of intent to operate a large Family Child Care Home at the renting property to the owner/landlord. Based on the information obtained during interviews, and LPA’ s File review, it has been determined that the above allegation is deemed Unsubstantiated. A finding that is unsubstantiated means, although the allegation may have happened or is valid, at the time of the investigation there is no preponderance of the evidence to prove that the alleged violation occurred. LPA observed LIC 9149 Property Owner/Landlord Consent on file dated May 06, 2013. According to interviews conducted prior to the renter’s agreement contact between the Landlord and licensee a verbally consent agreement was made between both parties. Licensee provided Tenant agreement and Child Care Insurance which required landlords’ authority for approval.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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-20231030095807
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: GRIJALVA FAMILY CHILD CARE
FACILITY NUMBER: 197418889
VISIT DATE: 11/02/2023
NARRATIVE
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Community Care Licensing(CCL) forms on file include Lic 9149 form completed and signed by landlord indicating consent for a large FCC dated on 5-06-2023.

On 6/6/2013 approval for a large family childcare Home was granted with relocation and increase of capacity. Based on interviews, information and documentation gathered allegation Licensee did not provide the landlord form LIC 9149 to sign and give consent to run a day care is unsubstantiated. Being that landlord is not providing consent at this time, Licensee's license will be decreased to a capacity of 12 children in care effective November 2, 2023 a new license will be generated with changes.

An exit interview was conducted, appeal rights, notice of site visit, and a copy of this report was provided to licensee on this date.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2