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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750011
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:37:23 PM

Document Has Been Signed on 06/14/2023 03:37 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:ADVENTUROUS LEARNING GROUPFACILITY NUMBER:
367750011
ADMINISTRATOR:SALTZMAN, ERIKAFACILITY TYPE:
850
ADDRESS:15011 BEAR VALLEYTELEPHONE:
(760) 948-5500
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 47TOTAL ENROLLED CHILDREN: 47CENSUS: 20DATE:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Erika Saltzman, DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
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On June 14, 2023, Licensing Program Analyst (LPA), Calloway made an unannounced inspection visit to the above facility. The purpose of visit was to conduct a Required Annual Inspection. LPA met with the Director who granted access and toured the facility with the Director inside and outside. Upon arrival, LPA observed 20-day care children, 13 Preschool and 7 toddlers and 4 staff members.
LPA observed parent boards with the required postings, fire/earthquake drills current, sign in and out sheets and facility roster are current. First Aid Kit, smoke alarm, carbon monoxide detectors (tested, operable), and fire extinguisher (several, all full/green).
Per Director, children are inspected for illnesses (wellness policy) as they arrive. There is a separate area for isolation and care of ill children at the entrance in a chair near the Director’s desk.
Physical Plant: The are four (4) classrooms and a Media Room. Furniture and equipment were inspected and are in good repair. All rooms are clean and safe. Telephone service (telephone in room) were verified. Heating, lighting, and ventilation are adequate. There are cubbies (labelled) for children's belongings in the classroom. LPA observed age-appropriate materials. Drinking water is available inside the classroom with a water jug and disposable cups. Napping equipment (mats) sanitized daily.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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: ADVENTUROUS LEARNING GROUP
FACILITY NUMBER: 367750011
VISIT DATE: 06/14/2023
NARRATIVE
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Bathroom: inspected and observed (other side of media room) 1 clean bathroom with 4 toilets, 4 sinks,) (boys and girls utilize the restroom separately). Toilets and sinks (working). Soap, toilet paper, and paper towels available.
Kitchen: (off limits, locked) No stove or sink. Equipped with microwave, refrigerator/freezer. Chemicals (locked) and food are kept in separate cabinets. Center provides AM, PM and evening snack, 2 lunches a week, 1 paid lunch (optional). Child bring own lunch 2 days a week. Menus are posted in the lobby, school age classroom and kitchen. Allergy lists are posted in kitchen and classroom. LPA observed an appropriate amount of food during the inspection. Expiration dates verified.
Ratios: Teacher child ratios were observed. Care and supervision were observed while teachers interacted with the children. Children's records and staff records were reviewed. Trainings for staff for Mandated Reporter CPR/First Aid are needed and immunizations needed.
Outside: Waiver reviewed for the outdoor play space. Outdoor play equipment was inspected for health, safety, good repair and age-appropriate toys, bikes, for play. The play area has cushioning material, sand, and concrete. The area was observed to be free of debris. There is an area for shade and rest. Children play at a separate time from school aged children. Igloo and Dixie cups brought outside during play. Play area was inspected and found to be free of hazards and inaccessibility to bodies of water.
Unusual incidents should be reported to licensing withing 24 hours of the occurrence with LIC 624B form. On duty worker is available, Monday through Friday 8:00 AM to 5:00 PM for reporting and questions. Lead Water testing was discussed.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: ADVENTUROUS LEARNING GROUP
FACILITY NUMBER: 367750011
VISIT DATE: 06/14/2023
NARRATIVE
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This facility does not provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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.
http://www.ada.gov/childqanda.htmSafe Sleep in Child Care: Resources can be found on our website at http://www.cdss.ga.gov/inforesources/Child-Care-Licensing/Public-Information-and-Resources/Safe-Sleep
Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.
Applicant advised visit www.shotsforschool.org for Immunization information.
Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.
There were deficiencies were cited during this inspection. Per Title 22 Regulations, See 809 D pages.
Exit interview was conducted. A copy of this report was read and left with Erika Saltzman, Director at the facility.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 06/14/2023 03:37 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 06/14/2023 at 03:25 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: ADVENTUROUS LEARNING GROUP
FACILITY NUMBER: 367750011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in S1 did not have the required immunizations inside staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Director will provide proof to Licensing by POC date of 6/28/23.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in two out of two staff S1 and S2 did not have required trainings were not is staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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Director will provide proof to Licensing no later than POC date of 6/21/23.
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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/14/2023 03:37 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 06/14/2023 at 03:25 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: ADVENTUROUS LEARNING GROUP
FACILITY NUMBER: 367750011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in one out of two staff member S1 did not have the required TB test inside staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Director will provide proof of the TB skin test to licensing by POC date of 6/28/23.
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in S2 did not have signed form in their staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2023
Plan of Correction
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Director will provide proof to Licensing no later than POC date of 6/21/23.
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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023


LIC809 (FAS) - (06/04)
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