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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364813683
Report Date: 11/08/2021
Date Signed: 11/08/2021 12:12:07 PM

Substantiated


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
08/13/2021 and conducted by Evaluator Justin Dorsey
COMPLAINT CONTROL NUMBER: 12-CC-20210813140949
FACILITY NAME:KIDCARE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364813683
ADMINISTRATOR:CARMEN RODRIGUEZFACILITY TYPE:
850
ADDRESS:15025 GRAVILLA ROADTELEPHONE:
(760) 955-6466
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:24CENSUS: 16DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Carmen RodriguezTIME COMPLETED:
12:24 PM
ALLEGATION(S):
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Child(ren) was injured while in care.
INVESTIGATION FINDINGS:
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On 11/08/21 Licensing Program Analysts (LPA's) Justin Dorsey and Babatunde Ibitoye conducted a complaint investigation at the facility to deliver complaint investigation findings. LPA met with director Carmen Rodriguez, who allowed LPA's to tour of the facility. Upon arrival LPA's observed 16 children with 2 staff members.
During this investigation, LPA received pertinent documents related to this investigation, which included the facility childrens roster and an unusual incident report related to Child #1's injury. LPA also interviewed the complainant, center staff, parents and children of the program. According to interviews with the director it was found that Child #1 and Child #2 were injured while in care. According to interviews it was found both children were injured on the monkey bars in the school-age program playground. Due to the hardness of the dirt under the monkey bars a Type B citation will be issued. Based on information obtained, interviews with relevant complaint parties, licensee, parents and children the allegations are deemed SUBSTANTIATED and a citation will be issued. A finding of substantiated means that allegations were valid because the preponderance of the evidence standard has been met.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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-20210813140949
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: KIDCARE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364813683
VISIT DATE: 11/08/2021
NARRATIVE
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An exit interview was conducted, a copy of this report read out, notice of site visit and appeal rights was given to director Carmen Rodriguez.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20210813140949
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: KIDCARE CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 364813683
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2021
Section Cited
CCR
101238.2(e)(1)
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101238.2 Outdoor Activity Space (e)(1) ...areas around and under high climbing equipment...and other...equipment shall be cushioned with material that absorbs falls. Sand, woodchips and peagravel, or rubber mats...produced for the purposes above, are permitted. This requirement is not met as evidenced by:
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Per Director the facility will add cushioning under the schoolage playground monkey bars and send proof to LPA Dorsey by POC due date 11/29/21.
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Based on interview the hardness of the dirt under the monkey bars on the schoolage program playground played a part in Child #1 and Child #2 getting injured while in care, which poses a potential Health, Safety or Personal Rights 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: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
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