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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364801544
Report Date: 07/26/2022
Date Signed: 07/26/2022 09:19:40 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/25/2022 and conducted by Evaluator Justin Giese
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20220425154713
FACILITY NAME:IMMANUEL BAPTIST PRE-SCHOOLFACILITY NUMBER:
364801544
ADMINISTRATOR:ALFORD, KIMBERLYFACILITY TYPE:
850
ADDRESS:28355 E. BASELINETELEPHONE:
(909) 862-6641
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:168CENSUS: 22DATE:
07/26/2022
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kimberly AlfordTIME COMPLETED:
09:15 AM
ALLEGATION(S):
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Child was injured by staff while in care
INVESTIGATION FINDINGS:
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On 07/26/2022 at time listed above Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of concluding a complaint investigation. LPA met with Director, Kimberly Alford, regarding the above allegation, which were received on 04/25/2022.

The following was alleged: Child was injured by staff while in care

This complaint investigation was referred and accepted by Community Care Licensing (CCL) Investigations Bureau (IB) on 04/26/2022. The complaint was investigated by IB Investigator B. Hudec. LPA Giese made an unannounced visit to the facility on 05/02/2022 for the purpose of initiating the complaint investigation. At time of visit, LPA Giese made contact with Facility Director, conducted interviews, and reviewed/collected facility records and supporting documentation. All Information and documentation collected by LPA was forwarded to CCL IB.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022
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 09-CC-20220425154713
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: IMMANUEL BAPTIST PRE-SCHOOL
FACILITY NUMBER: 364801544
VISIT DATE: 07/26/2022
NARRATIVE
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In addition to CCL IB’s independent investigation of the allegation, local law enforcement conducted an investigation as well. CCL IB determined the documents collected, records reviewed, and statements made by pertinent parties do not prove or disprove the allegation.

This agency has investigated the complaint alleging a child was injured by staff while in care. Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A NOTICE OF SITE VISIT WAS GIVEN. DIRECTOR WAS INSTRUCTED TO POSTED IT IN A PROMINENT LOCATION AT THE FACILITY. THE DIRECTOR UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.



An exit interview was conducted, A copy of this report and appeal rights were given to the Director during this inspection on 07/26/2022.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2