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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750152
Report Date: 06/07/2023
Date Signed: 06/11/2023 11:28:28 PM

Document Has Been Signed on 06/11/2023 11:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CALIFORNIA CHILDREN'S ACADEMYFACILITY NUMBER:
197750152
ADMINISTRATOR:AURA OSOYFACILITY TYPE:
830
ADDRESS:10896 LEHIGH AVENUETELEPHONE:
(323) 223-3312
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/07/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Andrea Fernandez, Program DirectorTIME COMPLETED:
01:22 PM
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Licensing Program Analyst (LPA) Maddox met with Program Director (PD) , Andrea Fernandez today for the purpose of conducting a Prelicensing inspection for an Infant Component. PD is requesting to be licensed for 24 Infants ages 0 - 2 yrs. There is a licensed Preschool located in the same building (SAN FERNANDO GARDENS CHILD CARE CENTER - 197404126). Days and Hours of Operation: Mon - Fri from 6:00 am to 6:00 pm.

INDOOR ACTIVITY SPACE

§ The activity area was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees and visitors. Indoor activity space for infants shall be physically separate from preschool and school-age components.

§ Floors of all rooms have a surface that is safe and clean - corrections needed, and a comfortable temperature for children shall be maintained at all times.-

§The infant care center was equipped with appropriate furniture and equipment including, but not limited to, cribs, cots or mats; changing tables; and feeding chairs. Furniture and equipment shall be maintained in good condition. Toys shall be safe, and shall not have sharp points or edges or splinters, or be made of small parts that can be pulled off and swallowed.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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§Equipment and furniture shall be assembled or installed according to the manufacturer's instructions.
§Indoor Drinking water will be filtered

§Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children (adult bathroom).

§First Aid Supplies located in the classroom, the Isolation area will be either the crib room or front reception area

? LPA verified center has a working telephone

§ Sign in and Out procedure? Manual

§ The licensee shall be responsible for ensuring that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.

§ LPA observed cubbies along the wall as you enter the classroom to store Infant belongings and also cubbies above the wall where Infant diapers and wipes will be stored.

§ LPA observed fully charged fire extinguishers, fully stocked first aid kits, and operable smoke and carbon monoxide detectors in the classroom

OUTDOOR

LPA toured the outside play area and observed the following:

A shaded rest area for the children. Staff will bring water outside for Infants, The yard was free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. The areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence is at least four feet high.

There are no bodies of Water on the premises

HEALTH RELATED SERVICES

Medications shall be kept in a safe place inaccessible to children.

A refrigerator shall be used to store any medication that requires refrigeration.

The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

INFANT FOOD SERVICE

§There shall be an individual feeding plan for each infant according to Section 1014277. The plan shall be completed and available for use prior to the infant's first day at the center.


§Highchairs or other appropriate seating equipment shall be used to seat infants during feeding. Infants who are unable to sit unassisted in a high chair or other seating equipment shall be held by a staff person or other adult for feeding.
§Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date. Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies.
§All kitchen, food-preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and vermin.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

NAPPING

§ LPA observed an Infant Sleep Room with 6 standard size cribs (1 crib designated as the emergency evacuation crib).

§ Cribs did not limit the ability of staff to see the infant.

§Crib mattresses were covered with vinyl or similar moisture-resistant material and maintained in a safe condition with no exposed foam, batting, or coils.

§Each crib, mat or cot shall be occupied by only one infant at a time.

§The sleeping area for infants shall be physically separate from the indoor activity space

§ Cribs, mats or cots shall be arranged to provide a walkway between cribs, mats or cots to allow staff to reach each infant without having to step over or reach over any other infant

§ Pacifiers shall be allowed in the crib, there shall not be anything attached to the pacifier. The pacifier shall be specific to the infant it is being given to.


§ Bumper pads shall not be used.

§There were no objects hanging above or attached to the side of the crib.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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§Staff are aware that a needs and services plan is required for Infants and shall be in writing and signed and dated by the infant’s authorized representative.
§ Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)].
§ The needs and services plan and the Individual Infant Sleeping Plan shall be maintained in the infant’s file and shall be available to the Department for review. The plan shall be updated as often as the authorized representative wants, or as necessary to reflect changes in any of the areas specified
Infant Changing Tables

LPA observed 2 Infant changing tables, both have padded surfaces no less than one-inch thick and were covered with washable vinyl or plastic. The sides of the changing tables have raised sides at least three inches high and located within arms reach of a sink.

POSTINGS


The following forms must be posted after licensure:
  • Facility license.
  • Personal Rights form (LIC 613A).
  • Menus.
  • Child passenger restraint system poster (PUB 269) completed with local health department phone number.
  • Daily activity schedule.
  • Facility Sketch (LIC 999).
  • Parent’s Rights Poster (PUB 393).
  • Notice of Site Visit (LIC 9213).
  • Any licensing report documenting a type “A” citation must be posted for 30 days.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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  • Any licensing report or other document verifying compliance or non-compliance with the Department’s order to correct a Type A deficiency must be posted for 30 days.
The following are measurements taken today:

The Indoor Activity Space

-area close to the play yard: 14 X 30 = 420/35 = 12

-middle area in front of cubbies:

8 X 10 = 80; 6 X 7 = 42.

80 + 42 = 124/35 = 4

-Activity Area: 16 X 20 = 320/35 = 9

TOTAL INDOOR SPACE = 25

OUTDOOR PLAY YARD

non-mobile infant area: 15 x 17.5 = 263/75 = 4

yard has a triangular shape: 70 X 41 = 2,870/75 = 38

TOTAL OUTDOOR SPACE = 42

BATHROOM

There is a bathroom located within the classroom, LPA counted 3 toilets and 2 sinks inside the bathroom and an additional sink directly outside of the bathroom

3 toilets and 3 sinks = 45

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: CALIFORNIA CHILDREN'S ACADEMY
FACILITY NUMBER: 197750152
VISIT DATE: 06/07/2023
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The following are needed prior to licensure:

Place padding around the cement poles on the play yard in an effort to prevent children from sustaining injuries if the happen to run into them

The boarders along the building on the play yard has chipping and peeling paint, also, there is a wood beam on top of the cement poles that has peeling paint

LPA observed the flooring in the nap room has several rust stains, LPA is requesting staff treat the flooring to remove the rust stains to provide a safe and healthy environment for Infants.

An exit interview was conducted, a copy of this report and Advisory Notice were provided to Program Director, Andrea Fernandez. After corrections are made, center will be licensed for the requested capacity of 24 children, Fire clearance has been received for the requested capacity.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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