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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750074
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:48:25 PM

Document Has Been Signed on 11/05/2024 04:48 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 PLACEFACILITY NUMBER:
367750074
ADMINISTRATOR/
DIRECTOR:		LILIANA VELASQUEZFACILITY TYPE:
850
ADDRESS:58967 BUSINESS CTR DR STE G-HTELEPHONE:
(702) 764-6544
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 15TOTAL ENROLLED CHILDREN: 13CENSUS: 11DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Facility Representative Liliana VelasquezTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On November 5, 2024, at 11:55am, 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 six preschool age children, five toddlers, and four staff members present at the facility.

During this inspection, interviews were conducted with staff, and records were reviewed. In addition, a safety inspection was completed at approximately 12:00pm.

Based on interviews and record review, C1 and C2 were left unsupervised in the Grand Hall classroom on October 28, 2024. While C1 and C2 were left unsupervised, inappropriate contact occurred between C1 and C2. Interviewees reported C1 and C2 were left unsupervised for approximately 15 minutes. The Licensee observed the inappropriate contact on the internal video monitoring system, and immediately went to the classroom and separated C1 and C2. Staff interviews reported this is the first time the children have been left unattended during nap time. A total of seven children were present at the time of the incident. Interviewees reported Staff 1 (S1) stepped out of the Grand Hall classroom during nap time prior to another staff member stepping in. After the incident, the Center obtained walkie talkies and intercoms for each classroom to enable better communication between staff.


Per LPA record review and interviews, (S1) meets the qualifications of a teachers aide. Based on interviews conducted on this date, S1 has supervised the preschool children in the classroom and in the lobby while S1 was not under the direct supervision of a teacher. A technical advisory notice was issued for regulation, 101216.2 (e) Teacher Aide Qualifications and Duties.
The Center was issued a type A citation for California Code of Regulations, Title 22, Division 12 Chapter 1, 101229 (a)(1) Responsibility for Providing. Refer to the attached LIC 809D.
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
FACILITY NUMBER: 367750074
VISIT DATE: 11/05/2024
NARRATIVE
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Report continued from page one
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.

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 04:48 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 11/05/2024 at 02:48 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: AZY'S PLACE
FACILITY NUMBER: 367750074

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
101229(a)(1)

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101229 (a)(1) Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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Per Facility Representative, walkie talkies were purchased and installed on October 29, 2024. The Center is in the process of hiring additional staff. Verbal supervision training was provided the day of the incident. Additional staff training will take place on November 8, 2024.
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Based on interviews and record review, C1 and C2 were left unsupervised in the classroom during nap on October 28, 2024. When alone and unsupervised inappropriate contact occurred between C1 and C2. This poses an immediate risk to the health, safety or personal rights of the persons in care.
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A copy of the training sign in sheet and agenda will be emailed to the Department.

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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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