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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419412
Report Date: 07/12/2019
Date Signed: 07/12/2019 03:07:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:KAI'S JUSTICE CHILDCARE CENTERFACILITY NUMBER:
197419412
ADMINISTRATOR:JONES, AKEMIEFACILITY TYPE:
840
ADDRESS:2307 E. PALMDALE BLVD.TELEPHONE:
(661) 947-5247
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:54CENSUS: 21DATE:
07/12/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Adrianne TolliverTIME COMPLETED:
03:23 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
Licensing Program Analyst (LPA) Neal met with director, Adrianne Tolliver, who guided LPA on a tour for the purpose of an Annual/Required inspection. The school age consists of 2 classrooms at this time. LPA toured and inspected the center, now located in Room #1 and Room #3, and observed 21 school age children in care with 2 teachers. Director will submit new facility sketches illustrating the changes made. The facility operates from 5:00 am to 11:00 pm Monday through Friday. This facility provides Incidental Medical Services - IMS.
Furniture and equipment in all rooms were inspected for age appropriateness, good repair, cleanliness and safety. Telephone service was verified. Heating, lighting, and ventilation are adequate. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water dispenser and disposable cups. Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness, as well as for hazards and inaccessibility to bodies of water. LPA observed age appropriate play equipment and an anchored jungle gym with sand underneath to cushion falls. There is an area for shade and rest and a concrete area for active play. Drinking water is available in the form of a water pitcher and disposable cups.
LPA inspected and observed 1 clean bathroom in room #1 with 4 toilets and 4 sinks. Per staff, children take turns using the restroom separately. There are also 2 individual restrooms in Room #3 (1 toilet, 1 sink). Sinks are functioning properly. LPA observed soap, toilet paper and paper towels readily available.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
VISIT DATE: 07/12/2019
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
There is a clean, fully equipped kitchen with refrigerator, freezers, stove/oven, dishwasher and microwave. The facility provides breakfast, lunch, evening snack and dinner. Menus are posted. Allergy lists are posted in each classroom and in the kitchen. Chemicals/cleaning supplies are kept separate from the food. Teacher/child ratios were observed and staff names recorded. Sign in/out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. The facility transports children at this time. A sample of children's records were reviewed.

Per director, full staff records are stored at the admin. office, however LPA reviewed a sample of staff files and will complete review at a later date. Current staff certification in Pediatric CPR/First Aid was observed (expires 1/10/2021). Director's Mandated Reporter certificate was observed completed on 2/14/2018. Director was reminded that mandated reporter training for child care must be completed every 2 years by all staff. Emergency and Fire Drill was last conducted July 8th.

Director was reminded to review quarterly updates , Title 22 Regulations and the Health & Safety code at the department's website www.ccld.ca.gov.

Children are inspected for illnesses as they arrive. A review of medication policy indicated that prescription medication is administered and only with parent's written permission. The director administers medication and documents the dosage, date and time onto a log. Medication is brought and taken home by the parent daily or retained in a locked filing cabinet properly labelled and stored in its original container.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
VISIT DATE: 07/12/2019
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
This facility provides Incidental Medical Services – IMS. LPA discussed 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

Director was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624.

The director was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited (LIC9224).



No deficiencies were cited during today's inspection.

Exit interview was conducted and a copy of this report was read and provided to Director.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3