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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700170
Report Date: 12/20/2022
Date Signed: 08/01/2023 11:25:35 AM

Unsubstantiated


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
10/12/2022 and conducted by Evaluator Justeene Tamayo
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20221012150424
FACILITY NAME:DONN FAMILY CHILD CAREFACILITY NUMBER:
197700170
ADMINISTRATOR:DONN, AMAKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 992-1401
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 2DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amaka Donn, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Allegation:

Neglect/Lack of Supervision: Licensee left day care children unattended
INVESTIGATION FINDINGS:
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On 08/01/23, Complaint Investigation Report dated 12/22/22 is amended to change the finding from substantiated to unsubstantiated.

On 12/22/22 Licensing Program Analysts (LPAs) Justeene Tamayo and Annelise Villa met with licensee Amaka Donn for the purpose of concluding the investigation concerning the above complaint allegations. LPAs toured the facility and observed 2 infants in care.

The investigation consisted of interviews with staff, children, and other complaint-relevant parties including the review of supportive documentation. During an interview conducted with the licensee, the licensee disclosed that on more than one occasion she had taken school-age children to the park and visually supervised the children from her car parked near the play area where the children were playing to pick up her phone or other items.

Please see LIC9099-C for Continuation Page
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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-20221012150424
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: DONN FAMILY CHILD CARE
FACILITY NUMBER: 197700170
VISIT DATE: 12/20/2022
NARRATIVE
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Based on the information obtained during interviews conducted, there is insufficient evidence to corroborate the allegation; therefore, the allegation has been found to be unsubstantiated.

An exit interview was conducted, and the report was reviewed with the licensee Amaka Donn, along with her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20221012150424
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: DONN FAMILY CHILD CARE
FACILITY NUMBER: 197700170
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
12/22/2022
Section Cited
CCR
102417(a)
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Operation of a Family Child Care Home 102417(a): The licensee shall be present in the home and shall ensure that children in care are supervised at all times.
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Licensee is aware if she is to take children for outside activities, she must be physically with the children to ensure the health and safety of children under her care.
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This requirement was not met as evidence by: Licensee admitted during more than occasion she left child #1, #2, and #3 physically unattended at the park, while she was sitting in her car. This is a type B deficiency that if not corrected, this can pose a potential 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: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3