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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750056
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:03:26 PM

Document Has Been Signed on 08/29/2024 01:03 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:MC DONALD LEARNING CENTERFACILITY NUMBER:
367750056
ADMINISTRATOR/
DIRECTOR:		LISA BURTNERFACILITY TYPE:
830
ADDRESS:796 ERWIN RANCH ROADTELEPHONE:
(909) 709-4041
CITY:BIG BEAR CITYSTATE: CAZIP CODE:
92314
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
08/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Facility Representative Casie Gilham and Administrator Lisa Burtner TIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On August 29, 2024 at 09:20am, Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Health and Safety inspection at the Center and met with facility representative Casie Gilham. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. Present during this inspection was one fully qualified infant teacher, and one aid providing supervision to seven infants.

At 09:35am. LPA conducted a safety inspection on the infant classroom. During the inspection, LPA observed child 1 (C1) in a crib with a pink blanket. LPA questioned the staff 1 (S1) about the presence of the pink blanket. S1 explained, C1s pacifier was attached to the blanket. S1 stated, they did not know the pacifier could not be attached to the blanket while the child was in the crib. LPA then observed facility representative Casie Gilham detach the blanket from the pacifier and remove the blanket from the crib where C1 was sleeping. C1 remained sleeping in the crib with a pacifier not attached to anything. LPA reviewed C1s safe sleep log for today August 29, 2024. Per record review, C1 fell asleep at 09:35am. The blanket the pacifier was attached to was approximately 8.5x11 inches. Staff referred to the blanket as a "lovey blanket"

Based on LPA observation, C1s pacifier was attached to a blanket. The Center was issued a type B citation for California Code of Regulations, Title 22, Division 12 Chapter 1 regulation, 101439.1(f)(1)(A) Infant Care Center Sleeping Equipment. Refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Administrator Lisa Burtner. Appeal Rights were provided.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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 08/29/2024 01:03 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 08/29/2024 at 10:06 AM
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: MC DONALD LEARNING CENTER
FACILITY NUMBER: 367750056

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2024
Section Cited
CCR
101439.1(f)(1)(A)

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101439.1 Infant Care Center Sleeping Equipment: (f) Cribs ...free from ...blankets...(1) Pacifiers shall be allowed ... if the following provisions...(A) There shall not be anything attached to the pacifier. This requirement was not met as evidenced by:
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Per facility representative, a staff training will occur with the infant teacher and aids. A copy of the training agenda and sign in sheet will be submitted to the Department by 9.5.24,
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Based on LPAs observation and interviews, the Licensee did not ensure there was nothing attached to a pacifier when C1's pacifier was attached to a blanket while C1 was sleeping in a crib. This poses a potential risk to the health and safety of 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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024


LIC809 (FAS) - (06/04)
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