<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750074
Report Date: 06/05/2025
Date Signed: 07/09/2025 04:32:14 PM

Document Has Been Signed on 07/09/2025 04:32 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:
(760) 288-9068
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 14DATE:
06/05/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Facility Representative Liliana VelasquezTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On July 9, 2025, at 1:45pm., Licensing Program Analyst (LPA) Zirbes met with the Facility Representative Liliana Velasquez. The purpose of the inspection was to conduct the unannounced Annual/Random inspection. LPA disclosed the purpose of the inspection to facility representative. Present during today’s inspection were five toddlers being supervised by staff 1 (S1) and staff 2 (S2) and nine preschool age children being supervised by the facility representative. The preschool center with a toddler component consists of four rooms (toddler playroom, Grand Hall, infant, nursery), one restroom, and Gym/Playroom. This Center also operates a school age center (367750046). The Center has a kitchen, one staff restroom, and two staff offices, which are utilized by both components. The Center is located in a business center. An approved waiver is on file for the outdoor space. The program operates Monday to Friday 07:00am - 06:00pm.
Indoor/Children's Area: The staff office door was open when LPA arrived to the Center at approximately 1:45pm. When LPA completed a tour with the facility representative Velasquez, at 2:49pm, LPA observed a bottle of Raid on a approximate four foot high cabinet in the staff office. During the inspection, LPA observed all children were in their individual classrooms and were under constant supervision by the staff, therefore this was a potential risk. LPA completed research on Raid products and per research Raid is a considered a poison. When the Raid bottle was discussed with the facility representative Velasquez they stated they did not know the Raid bottle was in the staff office. Based on LPA observation and record review Raid is a poison and is required to be locked. A type B citation was issued, refer to LIC 809D. At the time of this inspection, the infant and nursery classroom were not being utilized and were off limits to the children in care via child safety gates. These rooms were being used as storage areas. When LPA completed a tour of the toddler classroom, with facility representative Velasquez, LPA observed the trash can containing plates and food wrappers was not equipped with a lid. LPA observed the trash can in the preschool classroom also did not have a lid. LPA observed plates and food wrappers in the trash can. Report continued on page two
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: AZY'S PLACE
FACILITY NUMBER: 367750074
VISIT DATE: 06/05/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Report continued from page two
Facility Representative Velasquez expressed they did not know lids were required on the trash cans. LPA discussed the regulation with facility representative Velasquez. A technical advisory notice was issued. LPA observed all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean. Cleaning compounds were stored in a cabinet within the kitchen. LPA observed the indoor furniture/equipment was in good condition. Classroom was free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the Center had a variety of art supplies, games, and puzzles for the children. Children's belongings are stored cubbies. Drinking water is readily available indoors via children water bottles. All materials and surfaces are toxic free, window screens in good repair and free of debris. The carbon monoxide detector was tested by facility representative Velasquez, and was found to be in working order at the time of this inspection.

Restrooms: The preschool/toddler component shares one restroom. The restroom has two toilets and one sink. Toilets and sinks were functioning properly and are age appropriate. Paper towels, soap and other supplies were available.

Meals: The Center provides two meals and one snack a day. Menus were posted in the front entranceway and in the kitchen.

Napping: During this inspection, LPA observed the toddler and preschool children during nap time.

Outdoor: Currently there is zero outdoor space for the children. The school age program has an approved waiver on file for the outdoor play space. The Gym/Play room is utilizes for gross motor activities. LPA observed a padded floor with gymnastic mats, octagon climber, slide and a rock climber. Children have access to water while in the gym via personal water bottles.

Due to time constraints LPA was unable to complete the entire inspection and will return on a future date to complete the inspection.

As a result of this inspection, one type B and one advisory notice were issued. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Liliana Velasquez. Appeal rights were provided

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Kendal Zirbes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/09/2025 04:32 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 07/09/2025 at 03:29 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: 06/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)(1)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. (1) Storage areas for poisons shall be locked.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in when one bottle of Raid was observed on an approximately 4 foot high shelf in the staff office. When LPA arrived the door leading to the staff office was open, therefore the Raid was not locked as required, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2025
Plan of Correction
1
2
3
4
The Raid was removed and placed in a key locked container. Facility Representative stated a staff training will take place. A copy of the training and sign in sheet will be submitted to the Department.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Kendal Zirbes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5