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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360911141
Report Date: 03/20/2024
Date Signed: 03/20/2024 04:07:49 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
02/06/2024 and conducted by Evaluator Kendal Zirbes
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20240206165547
FACILITY NAME:PSD/DEL ROSA HEAD STARTFACILITY NUMBER:
360911141
ADMINISTRATOR:DEBBIE ARNOLDFACILITY TYPE:
850
ADDRESS:2382 DEL ROSA AVENUETELEPHONE:
(909) 883-0103
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:63CENSUS: 6DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
02:31 AM
MET WITH:Facility Representative Melissa RagagukgukTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff handled day-care child in a rough manner.
INVESTIGATION FINDINGS:
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On March 20, 2024, Licensing Program Analyst (LPA) Zirbes conducted a follow-up complaint inspection to PSD/Del Rosa Head Start. LPA met with facility representative Melissa Ragagukguk. The purpose of the inspection was to deliver the findings regarding the above complaint allegation. The investigation included an inspection of the facility, a review of facility records, and confidential interviews with staff, children, and parents.
On February 6, 2024, the Department received an allegation alleging staff 1 (S1) grabbed child 1 (C1) in a rough manner and threw C1 on the mat during nap time. C1 started crying and expressed S1 was hurting C1. This incident occurred during the week of January 17, 2024. Interviewees denied observing S1 handle any child in a rough manner. S1 was described as soft spoken and kind to the children. Over the course of the investigation, there were zero disclosures regarding S1 handling C1 in a rough manner. A review of the facility records indicated there was an incident that occurred on January 18, 2024, at 10:50 a.m., involving C1 and staff 3 (S3). Per an eyewitness written account, C1 was having a hard time during a transition. S3 was assisting C1 during the transition. Report continued on page two
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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-20240206165547
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: PSD/DEL ROSA HEAD START
FACILITY NUMBER: 360911141
VISIT DATE: 03/20/2024
NARRATIVE
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C1 began kicking S3, S3 then reached down and grabbed C1 by the upper right arm firmly and C1 cried. Additional staff members were present in the classroom during this incident and although they did not observe the incident, they heard C1 complain about S3 actions. Inconsistent information was received regarding if C1 received a mark or bruise because of this incident. Interviewees revealed this was an isolated incident and S3 was described as having positive interactions with the children in care. As a result of this incident S3s employment with the facility was terminated.

Based on the interviews conducted and a review of the records, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. A citation was issued on the LIC 9099D for California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101223 (a) (3).

A Notice of Site Visit was given and must remain posted for 30 days. An exit interview was conducted, and the report was reviewed with facility representative Melissa Ragagukguk.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 12-CC-20240206165547
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: PSD/DEL ROSA HEAD START
FACILITY NUMBER: 360911141
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2024
Section Cited
CCR
101223(a)(3)
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Personal Rights 101223 (a) The licensee shall ensure that each child is… (3)…To be free from corporal or unusual punishment, infliction of pain, humiliation... This requirement was not met as evidenced by:
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Per facility representative , S3 employment with the center was terminated january 23, 2024. In formal staff training regarding personal rights occured on 1.28.24 and 1.22.24. A Personal Rights training will occur with the staff on 3.21.24, a copy the Agenda and sign in sheet will be submitted.
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Based on interviews and record review, the Licensee did not ensure C1 was free from infliction of pain, when S3 grabbed C1 firmly on the upper right arm on January 18, 2024, which poses a potential Health, Safety or Personal Rights risk to the 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: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5