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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414043
Report Date: 11/22/2022
Date Signed: 11/22/2022 02:03:27 PM


Document Has Been Signed on 11/22/2022 02:03 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:CCRC HEAD START-MIGUEL MONTESFACILITY NUMBER:
197414043
ADMINISTRATOR:HERMINEH AZIZIANFACILITY TYPE:
850
ADDRESS:10675 TELFAIR STREETTELEPHONE:
(818) 834-2358
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY:39CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Hermineh AzizianTIME COMPLETED:
02:01 PM
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On 11/22/2022 Licensing Program Analyst(LPA) Isabel Ortega met with facility Director and conducted an Annual Random inspection. LPA Ortega announced the purpose of the inspection and was granted entry. LPA toured and inspected the facility in accordance with the facility sketch. Present today; no children in care and 7 staff.

There are a total of two classrooms and three sheds (maintained key locked).
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed individual storage with children’s name labeled for children's belongings. The classroom consists of filtered water pitchers with individual one time use disposable cups for children. An isolation area was inspected, which takes place in a private staff office. Children have the option for rest time if needed cots are provided. Blankets are provided and washed by parents weekly. Cot sheets are provided and washed weekly by the facility. Age appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms were found to be clean and sanitary.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043
VISIT DATE: 11/22/2022
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Facility operates Monday through Friday- State Preschool CSPP Classroom #1: from 7:30 a.m. to 5:30 p.m. and Regular Preschool classroom #2: from 7:30 a.m. to 3:30 p.m.

First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers were observed and in operable condition. Smoke and carbon monoxide tested at 10:28 a.m. Trash cans with tight lids were observed. The center participates in a Food Nutrition Program and provides breakfast, lunch and afternoon snack for children enrolled. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. There is hot running water in the food preparation area(main kitchen is off site), it is adequately equipped, clean, and free from hazards. Cleaning supplies are out of reach of children.

Emergency Drills are conducted monthly last drill was conducted and documented on 11/15/2022 at 9:45 a.m. The fire extinguisher (2A10BC) is reading in green and meets the Fire Marshal codes and standards (last serviced 10/04/2022).

Food allergies are noted and are posted in the food preparation area. Menu is posted visible for parents; hard copies are provided upon parent request and menu is also posted on Learning Genie for Parents App.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043
VISIT DATE: 11/22/2022
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The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures other play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children are provided with filtered water (pitcher) disposable one time use cups during outdoor play. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area. There are three sheds on the play area utilized for equipment and storage (maintained locked).

Facility maintains adequate teacher child ratio. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. A review of the sign in/out sheet was conducted to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.

Center Director and teachers are currently certified in Pediatric CPR/First Aid which expires on 04/5/2023. Facility was not able to provide the Child Care Provider Mandated Child Care Provider training(AB1207) certificate. A type B citation has been issued today.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043
VISIT DATE: 11/22/2022
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The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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/childqanda.htm

All staff are required to take 3-hour Child Care Provider Mandated Reporter(AB1207) training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations and Title V.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Director is aware self and all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hotline at (800) 540-4000.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043
VISIT DATE: 11/22/2022
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For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations facility is not in compliance, one B deficiency will be issued today. An exit Interview was conducted with facility Director Hermineh Azizian. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 11/22/2022 02:03 PM - It Cannot Be Edited

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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/13/2023
Plan of Correction
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Facility will complete Child Care Provider Training AB1207 for Director and all Staff and submit a copy by fax, email to the Palmdale Regional Office by Plan of correction due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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