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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197700170
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:38:51 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:
12/22/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amaka Donn, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Allegations:

Personal Rights: Licensee hit day care child with an object

Personal Rights: Licensee is using inappropriate forms of punishment
INVESTIGATION FINDINGS:
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On 12/22/2022 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. Concerning the allegation of licensee hit day care child with an object, interviews conducted with licensee revealed child #1 ask licensee to throw her a small juice box. Licensee threw the juice box to child #1 because child #1 wanted to catch the juice box, but the juice box accidently hit child #1 in the head. Child #2’s statements corroborated with licensee’s statements. Child #1 was going to catch the juice box, but child #1 missed it, and it accidentally hit child #1 in the head.

Concerning the allegation of licensee is using inappropriate forms of discipline, child #1, #2, and #3 statements were inconsistent. Licensee denied any inappropriate forms of discipline are being used on the children.

Please see LIC9099-C for additional information
Unsubstantiated
Estimated Days of Completion:
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
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-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: 12/22/2022
NARRATIVE
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A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegation occurred.

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: 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 2