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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750046
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:50:08 PM

Document Has Been Signed on 11/05/2024 04:50 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/
DIRECTOR:		SALEENA SMITHFACILITY TYPE:
840
ADDRESS:58967 BUSINESS CENTER DR STE GTELEPHONE:
(760) 228-9068
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 15TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:16 PM
MET WITH:Administrator Saleena Smith and facility representative Liliana Velasquez TIME VISIT/
INSPECTION COMPLETED:
04:55 PM
NARRATIVE
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On November 5, 2024, at 02:01 pm, Licensing Program Analyst (LPA) Zirbes, met with facility representative Liliana Velasquez and Licensee Saleena Smith to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report (UIR) submitted on to the Department on November 1, 2024. The unusual incident report was regarding a supervision incident involving child 1 (C1) and child 2 (C2). Upon LPAs arrival, there were zero school age children in care. At approximately 3:45 pm, three school age children arrived to the Center and were supervised by one teacher.

During this inspection, interviews were conducted with staff, and records were reviewed. In addition, a safety inspection was completed.

Based on interviews and record review, C1 a school age child was co-mingling with the preschool age children on October 28, 2024. While C1 was co-mingling with the preschool age children inappropriate contact occurred between C1 and C2. The Administrator reported, the Center was not expecting C1 to attend on October 28, 2024. Per Administrator, the Center made the decision to co-mingle C1 with the preschool children in care rather than have C1 remain alone in the school age classroom with the teacher for the day. Additional interviewees reported C1 co-mingled with the preschool children for one week. The Department received video evidence documenting C1 was in the Grand Hall classroom during nap time with the preschool age children. Interviews reported the incident occurred around 1:00pm. The Center does not have an approved waiver to co-mingle the school age and preschool children.

The Center was issued a type A citation for California Code of Regulations, Title 22, Division 12 Chapter 1, 101538.3(b) Indoor Activity Space. Refer to the attached LIC 809D.



LPA Zirbes informed facility representative Liliana Velasquez that this report dated November 5, 2024, 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. Report continued page two.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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: AZY'S PLACE CHILDRENS CENTER
FACILITY NUMBER: 367750046
VISIT DATE: 11/05/2024
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Report continued from page one

Also, LPA Zirbes informed the facility representative to provide a copy of this licensing report dated November 5, 2024, 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. An exit interview was conducted, and this report and appeal rights were reviewed with facility representative Liliana Velasquez.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/05/2024 04:50 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/05/2024 at 03:57 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: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2024
Section Cited
CCR
101538.3(b)

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101538.3(b) Indoor Activity Space for School-Age Children: In combination programs, indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children. This requirement is not met as evidenced by:
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Per facility representative, the Center will ensure school age and preschool children are in separate areas of the Center. A staff training will take place on 11/8/24. A verbal training occurred with the staff on 10/28/24.
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 Based on record review and interviews, C1 a school age child was not separate from the preschool children on 10/28/24. C1 and C2 engaged in inappropriate contact in the preschool classroom, this posed an immediate risk to the health and safety of persons in care.
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A newsletter will be sent to the parents informing them of the daily drop off procedures and changes in schedule of 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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


LIC809 (FAS) - (06/04)
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