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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750152
Report Date: 11/20/2024
Date Signed: 11/20/2024 03:24:36 PM

Document Has Been Signed on 11/20/2024 03:24 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/
DIRECTOR:		AURA OSOYFACILITY TYPE:
830
ADDRESS:10896 LEHIGH AVENUETELEPHONE:
(323) 223-3312
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
11/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:44 PM
MET WITH:Jardi Solares, Lead Teacher TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On November 20, 2024, Licensing Program Analyst (LPA) Isabel Ortega met with Lead Teacher, Jardi Solares to conduct an unannounced Case Management Inspection. The purpose of this case management is to follow up on a self reported unusual incident report (UIR) submitted to the Department on 11/19/2024.

The unusual incident report is regarding an incident that occurred during child care hours of operation at 9:05 a.m. A child was injured during care and sustained an open wound.

Upon arrival, there were 12 children observed in care and 6 staff proving care and supervision.

During this inspection LPA was provided with the facility roster and relevant documentation related to the incident. LPA toured the infant facility according to the facility sketch. In addition, LPA completed a safety inspection of the facility and observed the area where the incident occurred.

During the incident that occurred on 11/19/2024 there were seventeen children present and eight staff proving care and supervision.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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: 11/20/2024
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According to interviews conducted, staff #1 was supervising children and getting the art table ready. According to Staff #1 a green sheet of paper was placed on the table for a activity. Child #1 attempted to place hand on the table when child lost balance, fell, hitting the right side of eye against the edge of the table. Staff #1 attempted to reach child but was not able to reach child#1 on time. LPA observed the table to consist of round edges and in good repair. According to facility staff #1 was at close proximity to children and maintained visual supervision to the three children assigned to Staff #1's group.

Parent was notified in a timely manner by phone at 9:35 a,m, and child was picked up at 10:15 a.m. According to the facility child's representative was provided with a letter to cover Doctor visit treatment and an incident report was also provided to parent by S.F.G. campus. Facility provided first aid- an ice pack was applied on child #1's injury. According to Staff the Corporate office was also notified to follow up with child's progress. According to facility staff, the corporate office contacted child's #1 representative and was informed child#1 is doing well and received glue/paste treatment to close open right eye wound. Child #1 is resting at home and will return to day care on Monday, 11/25/2024.

Incident has been determined to be an accident when child #1 lost balance and sustained an injury during day care hours. No citations issued, Staff #1 has been instructed by facility to prep activities prior to having children in the activity area.

A notice of site visit was provided and requested to be posted for 30 days. An exit interview was conducted, a copy of this report, notice of site visit and appeal rights were provided to facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2024
LIC809 (FAS) - (06/04)
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