197414043-11-30-2023-12-CC-IORA-CY3TLF-20231130134928

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414043
Report Date: 11/30/2023
Date Signed: 11/30/2023 01:49:38 PM

Document Has Been Signed on 11/30/2023 01:49 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 MONTES		FACILITY NUMBER:	197414043
ADMINISTRATOR:	HERMINEH AZIZIAN		FACILITY TYPE:	850
ADDRESS:	10675 TELFAIR STREET		TELEPHONE:	(818) 834-2358
CITY:	PACOIMA	STATE: CA	ZIP CODE:	91331
CAPACITY:	39	CENSUS: 20	DATE:	11/30/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Azizian Hermineh		TIME COMPLETED:	01:50 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 11/30/2023 Licensing Program Analyst (LPA), Isabel Ortega met with facility Director, Azizian Hermineh and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 20 children in care and 6 staff providing care and supervision. Facility operates in two classrooms. An isolation area was inspected, which takes place in the main office. Children have the option for rest time and quiet time if needed. Facility provides sheets for cots and are washed weekly. Parents bring blankets and are taken home every Friday for wash. Children are provided with cots for rest time when needed. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms are cleaned, restocked of toiletries by on-site custodian, Facility is also disinfected, and sanitized daily. There is a total of two classrooms currently being utilized for childcare. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and AC ventilation were evaluated.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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: CCRC HEAD START-MIGUEL MONTES	FACILITY NUMBER: 197414043
	VISIT DATE: 11/30/2023

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LPA observed individual storage with children’s name and belongings. Facility provides filtered water from the kitchen in a pitcher for indoor and outdoor(disposable cups observed). Children bring their own water bottles from home; facility also has individual disposable cups available.

Facility operates full time care Classroom #1 operates(Sate Preschool) Monday through Friday from 7:30 a.m. 5:30 p.m. and Classroom #2 operates Monday through Friday from 7:30 a.m. to 3:30 p.m. Facility provides breakfast, lunch and an afternoon snack for children enrolled and for state preschool classroom #1 two afternoon snacks are provided.

Facility has all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, carbon monoxide (tested 11:30 a.m.) are observed to be operating properly. The fire extinguisher (2A10BC) is reading in green (last serviced on (11/03/2023) and meets the Fire Marshal codes and standards.

Trash cans with tight lids were observed. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. A refrigerator is adequately equipped, clean, and free from hazards. Cleaning supplies are out of reach of children.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

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: CCRC HEAD START-MIGUEL MONTES	FACILITY NUMBER: 197414043
	VISIT DATE: 11/30/2023

NARRATIVE

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Emergency Drills are conducted every sixth month last drill was conducted and documented on 11/29/2023 at 10:00 a.m. Food allergies are noted and are posted in the food preparation area and in each classroom.

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. During outdoor play children are provided with filtered water in a water pitcher(disposable cups are available). 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.

The parent board was reviewed and has all the required forms. The menu is posted in the kitchen area and in each classroom. Menu is also provided to parents through Learning Genie and a tangible copy is available upon parent request.

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.

Directors and teachers are currently certified in Pediatric First Aid and Pediatric CPR which expires until 04/05/2025. Child Care Provider Mandated Reporter (AB1207) training is dated 11/22/2022.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: 11/30/2023

NARRATIVE

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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 the 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.

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. 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 Hot-line at (800) 540-4000.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: 11/30/2023

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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/

Per Title 22 Regulations facility is complying with rules and regulation, no deficiency will be issued today. An exit Interview was conducted with Director Azizian Hermineh. A copy of this Report, a Notice of Site Visit (NOA)and appeal rights were provided on this day.

A copy of this report must be made available to the public for 3 years. The NOA shall be posted visible to parents for 30 days.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023

LIC809 (FAS) - (06/04)

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