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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750046
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:40:21 PM

Document Has Been Signed on 11/01/2023 04:40 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:AZY'S PLACE CHILDRENS CENTERFACILITY NUMBER:
367750046
ADMINISTRATOR:SALEENA SMITHFACILITY TYPE:
840
ADDRESS:58967 BUSINESS CENTER DR STE GTELEPHONE:
(760) 228-9068
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 3DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Administrator Saleena Smith TIME COMPLETED:
04:55 PM
NARRATIVE
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On November 1, 2023, at 2:45 p.m. Licensing Program Analyst (LPA) Zirbes and Maddox met with the Administrator Saleena Smith and facility representative Liliana Velasquez. The purpose of the inspection was to conduct a health and safety check. Present during today’s inspection were three children, ages 13, 9, and 4. LPA observed two staff members on site, the Administrator and Staff 1 (S1).

At approximately 1:45p.m LPA Maddox and Zirbes conduced a safety inspection with the Administrator. LPAs observed Child 1 (C1) alone in the unlicensed toddler classroom sleeping on a cot. The classroom lights were off, the door leading to the classroom was open. At approximately 2:40pm, LPAs conducted a walk through of the Center with S1. LPAs observed C1 alone and sleeping in the toddler classroom with the lights off. When interviewed regarding the supervision of C1, S1 expressed S1 is usually in the classroom while C1 is sleeping and expressed cameras are present in the classroom.


Based on LPAs observation, the licensee did not ensure C1 was under the supervision of a teacher at all times. A Type A deficiency is being cited based on LPAs observation, in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding absence of supervision warrants an immediate civil penalty of $500 and is hereby assessed, see LIC421IM.

LPA Zirbes informed Administrator that this report dated 11/1/2023, documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Zirbes informed the Administrator to provide a copy of this licensing report dated 11/1/2023 that documents any Type A citation 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 file for verification.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Administrator Saleena Smith.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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Document Has Been Signed on 11/01/2023 04:40 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/01/2023 at 03:21 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: AZY'S PLACE CHILDRENS CENTER
FACILITY NUMBER: 367750046

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide...(1) No child(ren) shall be left without the supervision of a teacher at any time.... This requirement was not met as evidenced by: Based on observation, the
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Per Administrator, a staff member immediately placed in the room with C1. A staff training will be conducted regarding supervision. A copy of the sign in sheet for the training will be submitted to CCL. Center will ensure no child is left without supervision again
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licensee did not ensure C1 was not left without supervision, as C1 was observed alone in the toddler room at 1:45pm and 2:40pm which poses an immediate health and safety risk to children in care. Civil penalty of $500 was assessed.
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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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023


LIC809 (FAS) - (06/04)
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