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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750162
Report Date: 11/12/2024
Date Signed: 11/12/2024 01:22:06 PM

Document Has Been Signed on 11/12/2024 01:22 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:ACADEMY OF EXCELLENCEFACILITY NUMBER:
197750162
ADMINISTRATOR/
DIRECTOR:		BEVERLY MOODYFACILITY TYPE:
830
ADDRESS:1324 WEST AVENUE J SUITE 5TELEPHONE:
(661) 206-9344
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
11/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Licensee Chauncey SmithTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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On 11/12/2024 at 12:10pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Licensee Chauncey Smith according to the facility sketch. Upon arrival, LPA observed 4 children with 2 staff member providing care and supervision.

During this inspection, LPA returned the original personnel file that was received on a prior visit. At 12:19pm, LPA Pittman and Staff 2 entered the infant classroom. LPA Pittman observed in the infant classroom that Child 1 was sleeping on their stomach in the crib. Additionally, there was a blanket in the crib with the infant; however, there was no fitted sheet on the mattress. LPA Pittman interviewed Staff 1 to inquire why the infant was sleeping on their stomach and Staff 1 stated they believed that the child could sleep on their stomach because the infant could roll over. LPA reviewed Child 1's file and determined they are not 12 months old. Staff 2 admitted that they believed the infant could sleep on their stomach because they could roll over as completed on the LIC 9227 Form. LPA inquired of the fitted sheet for the mattress and the blanket from Staff 2. Staff 2 stated that they believed the child could have the blanket and that the sheets were being washed and were being dried and believed they could place the sheet once they were finished being laundered. LPA Pittman informed the Staff 1 and Staff 2 of the policy regarding infants and sleeping equipment, fitted sheets, and blankets; also, when children are able to not sleep on their back and utilize cots and blankets. Staff 2 immediately removed the blanket from Child 1's crib, placed a fitted sheet over the crib's mattress, and placed the infant on the mattress with a fitted sheet. This is a Type B violation, see the LIC 809D for the details.

Additionally, technical assistance was provided for the technical violation of there not being a physical separation between the infant sleeping area and the indoor activity space. Technical assistance was provided for ensuring blankets are not in the infant's cribs and fitted sheets are on the crib mattresses that go to the bottom of the mattress and cannot be dislodged.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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Document Has Been Signed on 11/12/2024 01:22 PM - It Cannot Be Edited


Created By: Andrea Pittman On 11/12/2024 at 12:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2024
Section Cited
HSC
101430(a)(3)(A)

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101430 Infant Care Activities (a) ... the following shall apply: (3) All infants shall...(A) Staff shall place infants up to 12 month of age on their backs for sleeping.
This requirement was not met as evidenced by:
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The Director will complete a training about Safe Sleep and the Licensee will e-mail the signatures of the staff attending the training no later than 11/26/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above by allowing Child 1 to sleep on their stomach, without a fitted sheet on the mattress, and with a blanket which poses a potential health, safety or personal rights risk to 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.
SUPERVISOR'S NAME:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 11/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/12/2024


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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750162
VISIT DATE: 11/12/2024
NARRATIVE
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As a result of the inspection, the facility was found to be in noncompliance with Title 22 Regulations and has been cited one Type B deficiency, see the LIC 809D for the details.

All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, and a copy of this report was read and provided to the Licensee along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC809 (FAS) - (06/04)
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