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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197750170
Report Date: 04/22/2024
Date Signed: 04/22/2024 05:11:31 PM

Substantiated


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
01/30/2024 and conducted by Evaluator Andrea Pittman
COMPLAINT CONTROL NUMBER: 12-CC-20240130151752
FACILITY NAME:CCRC 10TH STREET HEAD STARTFACILITY NUMBER:
197750170
ADMINISTRATOR:BEATRIZ ZAMORANO-PEDREGONFACILITY TYPE:
850
ADDRESS:44236 10TH ST WESTTELEPHONE:
(661) 494-7999
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:80CENSUS: 17DATE:
04/22/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Center Director Carla MoralesTIME COMPLETED:
04:35 PM
ALLEGATION(S):
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Physical Plant
Record Keeping
Record Keeping
INVESTIGATION FINDINGS:
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On 4/22/2024 at 4:00pm, Licensing Program Analysts (LPAs) Andrea Pittman and Crystal Ali conducted an unannounced complaint visit to deliver the findings at the facility and was met by the Facility Representative who permitted entry to the facility. LPAs toured the facility with the Center Director according to the facility sketch. Upon arrival, LPAs observed 17 children with 8 staff members providing care and supervision.

During this investigation, LPA received pertinent documents related to this investigation, which included the facility’s staff and children’s rosters, personnel records, and other relevant investigation documents. In the weeks leading up to the complaint, the following represents what transpired at the center. The investigation revealed the following information:

Continue to next page
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
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 5
Control Number 12-CC-20240130151752
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/22/2024
NARRATIVE
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Allegation 1: The first allegation states that the facility was continued to operate in conditions that were not operable and unsafe. During interviews the following was discovered, there was a power outage that occurred on 12/12/2023 from approximately 10:00am to 2:40pm in the facility. Multiple staff disclosed that the conditions in the classrooms made it unsafe and the classrooms inoperable by the following: initially the lights went out and there were some exit signs providing light in the classroom but the children’s restroom was completely dark; around 12pm, the lights went out completely and there were no lights in the classroom as the emergency exit signs went out and the classrooms were extremely dark; staff stated based on visibility they were able to partially see when the exit signs were on, however, Staff 3 stated they were unable to effectively supervise the children and did notify the Center Director but was instructed to wait and Staff 2 stated they were unsure how safe the children were in the visibility; also around 12pm, staff stated that the classrooms dropped to 62 degrees; staff stated that the conditions in the classrooms made some children hot and others cold and some children were putting on jackets to get warm while others were taking off jackets to cool off; staff mentioned that the children were scared by the darkness; there was a child that was crying and had to be comforted from being in the darkness; another child was suspected to have had an accident and soiled their clothes in the darkened classroom and had to be changed; staff stated that children were afraid of the dark and crying while the lights were out while other children questioned the staff about the lights being out; multiple staff members mentioned the conditions in the classrooms to the Center Director who then notified the Supervisor over the facility, however, the Center Director was informed by the Supervisor to keep the facility open and not contact the parents. Although staff notified management of the inoperable conditions, the Supervisor kept open the facility in violation of Title 22 Regulations. This is a Type B citation, see the LIC 9099D for the details.

Allegation 2: The second allegation states that staff did not ensure that immunization records were not complete for the day care children. In January 2024, during the annual inspection, the LPA notified the management staff that they needed to complete the form PM-286 or similar form and track and document the immunizations for the children in care to ensure that immunizations are received timely. During the investigation, it was found that the health team and advocates are responsible in ensuring that immunizations are updated on the PM-286 or similar form and tracked and documented to ensure immunizations are received according to Title 22 Regulations; however, LPA followed up on two subsequent visits following the initial complaint visit to see if the forms had been completed and they had not. The advocate was able to provide proof of the completed documents for all children attending on 2/27/2024. This is a Type B citation, see the LIC 9099D for the details.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 12-CC-20240130151752
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
VISIT DATE: 04/22/2024
NARRATIVE
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Allegation 3: The third allegation states that staff allowed a child in care to be picked up by an unauthorized adult. During the investigation, the LPA found that there was a child in care that has a court order on file restraining the non-custodial parent; however, the court order document has been altered and the original information has been covered and is illegible. The LPA inquired if an unaltered copy had been requested of the custodial parent and they stated there was an attempt made to get an unaltered copy; however, it was never provided by the parent. The advocates were instructed by management to allow the child to be picked up by the non-custodial parent with the restraining order despite the court order that could order against it but the center did not ensure the safety of the child by acquiring an unaltered copy. This is a Type B citation, see the LIC 9099D for the details.

Based on information obtained, observations, and interviews with relevant complaint parties, the Allegation is deemed substantiated for allegations 1, 2, and 3; as a result, Type B citations will be issued for all three allegations. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met.

An exit interview was conducted, a copy of this report read and provided to the Center Director, and the Notice of Site Visit and Appeal Rights was explained and given to the Center Director.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 12-CC-20240130151752
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2024
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds
(a) The child care center shall be …in good repair at all times to ensure the safety and well-being of children, employees and visitors
This requirement is not met as evidenced by...
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Director will create a plan to ensure the facility will operate when in good repair via e-mail no later than 5/6/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by allowing the continued operation of the facility while the facility was not in operable condition and children and staff were negatively impacted by it which poses a potential health, safety or personal rights risk to persons in care.
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Deficiency Dismissed
Type B
05/06/2024
Section Cited
CCR
101220.1(g)(1)
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101220.1 Immunizations(g) The licensee shall document each child's immunizations...shall maintain such documentation…(1)... includes updating each child's immunization record when the child is due… This requirement is not met as evidenced by
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The Director previously provided proof of the completion of the PM 286 forms in person.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above as they did not complete the form PM-286 or similar and which poses a potential health, safety or personal rights risk to persons 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: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 12-CC-20240130151752
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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750170
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2024
Section Cited
CCR
101221(f)
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101221 Child's Records
(f) The information specified…above shall be updated as necessary to ensure the accuracy of the child's record.

This requirement is not met as evidenced by
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Director will create a plan to ensure that proper documents are accepted for court orders via e-mail no later than 5/6/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above as they did not request an unaltered copy of the court order to ensure the accuracy of the child’s list of authorized representatives record which poses a potential health, safety or personal rights risk to persons 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: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5