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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 367700249
Report Date: 04/26/2023
Date Signed: 05/08/2023 11:51:20 AM

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
02/28/2023 and conducted by Evaluator Kuliema Calloway
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20230228141606
FACILITY NAME:KOHLER FAMILY CHILD CAREFACILITY NUMBER:
367700249
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
04/26/2023
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Laura Kohler, LicenseeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Allegation #1 – Licensee handled child in a rough manner.
Allegation #2 – Licensee yells at child in care.

INVESTIGATION FINDINGS:
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On April 26, 2023, Licensing Program Analyst (LPA) Kuliema Calloway made an unannounced inspection to the Kohler Family Child Care Home. The purpose of the visit was to deliver findings for the above allegation(s). LPA met with licensee who granted access.

During the investigation. LPA conducted confidential interviews. Based on the interviews and observation there were consistent statements from everyone interviewed regarding the incident that occurred on 02/27/2023. The evidence determined Staff 1 handled Child 1 with lack of patience by grabbing the child’s arm to control the child in front of other day care children and yelling at Child 1 trying to control Child 1's behavior. The above Personal Rights violations are Substantiated meaning, the preponderance of the evidence standard has been met.
The facility was cited two Type A deficiencies see complaint investigation report LIC 9099 D for deficiencies cited.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
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-20230228141606
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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
VISIT DATE: 04/26/2023
NARRATIVE
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 LPA Calloway informed licensee to provide a copy of this licensing report dated 4/26/2023 that documents Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's files for verification.

An exit Interview was conducted and A copy of this report, Notice of Site Visit, and Appeal Rights were discussed and provided to the licensee, Laura Kohler . A Notice of Site Visit was posted and must remain for 30 days. Removal of the posting is subject to $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20230228141606
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: KOHLER FAMILY CHILD CARE
FACILITY NUMBER: 367700249
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/27/2023
Section Cited
CCR
102423(a)(1)
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102423(a)(1) Each child receiving svcs from..childcare shall have...rights that shall not be waived...by the licensee regardless of consent...from child's... rep...(1)To...treated w/dignity... relation- ship w/staff & other persons. This requiremnt is not met as evidenced by:
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Licensee will provide awritten declaration to the Department by 4/27/2023 stating they understand they are not to violate the Personal Rights of children in care. Licensee will take a behavioral training class & provide proof of the training to the Department by: 5/26/23.
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Based on interviews and observation, licensee restrained Child 1 to control their behavior, by grabbing the child by the arm. This poses an immediate Health, Safety, or Personal Rights risks to the persons in care.
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Type A
04/27/2023
Section Cited
CCR
102423(a)(4).
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102423 (a)(4) Each child receiving svcs from..childcare shall have...rights that shall not be waived...by the licensee regardless of consent...from child's... rep.(4)To...be free from...humiliation ...mental abuse...This requiremnt was not met as evidenced by:

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Licensee will provide awritten declaration to the Department by 4/27/2023 stating they understand they are not to violate the Personal Rights of children in care. Licensee will take a behavioral training class & provide proof of the training to the Department by: 5/26/23.
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Based on interviews and observation, licensee yelled at daycare child in front of other day care children. This poses an immediate Health, Safety, or Personal Rights risks 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: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3