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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414043
Report Date: 02/09/2024
Date Signed: 02/09/2024 03:34:22 PM


Document Has Been Signed on 02/09/2024 03:34 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: 20DATE:
02/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Azizian HerminehTIME COMPLETED:
03:45 PM
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On 2/09/2024, Licensing Program Analyst (LPA)Isabel Ortega met with Director, Azizian Hermineh to conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received on 1/31/2024 at the Palmdale Regional Office.

The incident occurred on 1/25/2024, child#1 was having lunch and staff noticed child#1 was placing two fingers in their mouth and began to choke on food. Child#1 had been congested due to a cold and is currently working on healthy eating habits which consist of pacing food intake.

Upon arrival, LPA observed 20 children in care 6 staff members providing care and supervision.

During this inspection LPA conducted interviews with 3 staff. In addition, LPA completed a file review, staff are currently certified in Pediatric First Aid/CPR.

During the inspection, LPA obtained copies of facility roster and health check report provided to parent and signed by parent, and staff on 1/25/2024.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024
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: CCRC HEAD START-MIGUEL MONTES
FACILITY NUMBER: 197414043
VISIT DATE: 02/09/2024
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Due to interviews conducted and information gathered, facility reacted quickly and followed protocol in a timely manner. Staff #1 administered the Heimlich Maneuver and no further medical attention was needed. Child continued to eat and finished lunch. Parent was notified and child#1 continued day as normal.

According to facility during lunch child is getting 1:1 support and on 2/16/2024 child#1, parent#1, and staff will have a meeting on how to support and discuss strategies and development a plan best for child#1.

Also, at the time of the incident four staff members were present providing care and supervision. Therefore, no citations will be issued today.

A notice of site visit, appeal rights and report were provided to Director Azizian Hermineh.

The notice of site visit shall remain posted for 30 days.

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

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC809 (FAS) - (06/04)
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