150405678-3-29-2024-12-CC-BBEO-D3TLB6-20240329083613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 150405678
Report Date: 03/12/2024
Date Signed: 03/29/2024 08:36:39 AM

Document Has Been Signed on 03/29/2024 08:36 AM - 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:	LION'S DAY CARE / PRESCHOOL		FACILITY NUMBER:	150405678
ADMINISTRATOR:	SIMON, DEBORA		FACILITY TYPE:	840
ADDRESS:	3012 MT. PINOS WAY		TELEPHONE:	(661) 245-1139
CITY:	FRAZIER PARK	STATE: CA	ZIP CODE:	93225
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	03/12/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Debora Simon		TIME COMPLETED:	03:00 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 3/12/24, Licensing Program Analyst (LPA) Beneroso met with the facility Debora Simon for the One Year Required inspection. The purpose of the inspection was disclosed and director guided LPA on a tour of the facility. Upon arrival LPA did not observe children present but 3 staff were observed . The hours of operation for the school age license is 02:30 pm- 5:00 PM – Monday - Friday Indoor/Children’s Area: There is currently one classroom operating in the facility. The room was observed to be clean and sanitary; floors of all rooms have a surface that is safe and clean. Furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, and personal belongings. There is an assigned area for sick/ill children in a room next to the main entrance. All indoor passageways, stair ways, incline, ramps, open porches, and other areas of potential hazard are kept free of obstruction. There is a working telephone on the premises. Facility maintains a comfortable temperature at all times. Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors. Drinking water is available inside the center in the form of filtered water. Facility has a waiver for Lead Exceedance Testing. There are working Carbon monoxide detectors, smoke detectors and Fire Extinguishers in all the classrooms (3A40BC).

Mariela Ramon
Barbara Beneroso
	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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: LION'S DAY CARE / PRESCHOOL	FACILITY NUMBER: 150405678
	VISIT DATE: 03/12/2024

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Health Related Services/IMS: This facility does not currently provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childquanda.htm

Food Service: The facility currently is offering Snacks, children bring lunch from home. Snacks are stored in a safe area away from chemicals or other harmful materials.

Restrooms: LPA inspected and observed two restrooms. Classrooms are divided by gender. Toilets were observed to be in operable condition. LPA observed bathrooms to have soap, toilet paper and paper towels readily available. Water temperature is appropriate.

Outdoor: The facility has one playground/outdoor area divided into two (school age and preschool) All outdoor and indoor passageways, stair ways, incline, ramps, open porches, and other areas of potential hazard are kept free of obstruction; Outside play area is completely fenced. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There is a grass area and sand area for active playing. The area was observed to be free of debris, free from hazard, holes, broken items, debris, cushioning material underneath. No bodies of water were observed. There are areas for shade and rest.

Children/Personnel Records: Site Supervisor and Staff qualifications were verified. Children’s files were observed to be complete. Staff records were observed to be incomplete. Vaccination records were missing for two of the staff members.

Facility Records: Roster, sign in and out sheets and fire/disaster drill log (completed on 03/06/2024) were also observed to be maintained as required.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, earthquake preparedness checklist.

Lead Exceedance: Facility has a waiver for the Lead Exceedance testing on file

SUPERVISOR'S NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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: LION'S DAY CARE / PRESCHOOL	FACILITY NUMBER: 150405678
	VISIT DATE: 03/12/2024

NARRATIVE

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Provider Information Notices (PINs) & Child Care Advocates: You can now sign up for Quarterly Updates on Rules, Regulations, Policies and PINs for one or more programs through our DSS website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe Applicant was informed all forms pertaining to Child Care Licensing can be found at https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Child Care Advocates Program: Provides information and resources about licensed childcare. www.childcareadvocatesprogram@cdss.ca.gov

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Site Supervisor shall permit the Department to inspect the Child Care Center, and to privately interview children or staff, to determine compliance with or to prevent violations of childcare center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

There was one Type B Citation issued during this visit. Exit interview conducted and report was reviewed with Director Debora Simon. A copy of this report was provided electronically along with her appeal rights and Notice of Site Visit. A notice of site visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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: LION'S DAY CARE / PRESCHOOL	FACILITY NUMBER: 150405678
	VISIT DATE: 03/12/2024

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Advisory/Other: The First Aid kits were observed in each classroom and were observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. CPR/First Aid is maintained current, the expiration date is 06/13/2025, Mandated Reporter Training is maintained current, it expires on 04/07/2024. Electrical outlets are inaccessible, recalled and or prohibited toys or play equipment were not observed on the premises. There are no window cords accessible to children. No Smoking prohibited on the premises, daily inspection for illness, no prohibited childcare items observed. Firearms/weapons are not allowed or stored on premises.

Medications/ Hazardous Materials: There are no medications stored in the facility. Cleaning compounds were observed to be stored in a locked closet. There are no firearms in the facility and no one smokes. .

Director was advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the Child Care Center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/29/2024 08:36 AM - It Cannot Be Edited

Created By: Barbara Beneroso On 03/12/2024 at 01:37 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: LION'S DAY CARE / PRESCHOOL	FACILITY NUMBER: 150405678
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on(observation and record review, the licensee did not comply with the section cited above. LPA did not observe vaccination records for two of the assistants present in the facility. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/26/2024
	Plan of Correction
1 2 3 4	Licensee agrees to submit proof of shot records to LPA Beneroso no later than 03/26/2024

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.

SUPERVISOR'S NAME:

Mariela Ramon

LICENSING EVALUATOR NAME:

Barbara Beneroso

LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC809 (FAS) - (06/04)

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