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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419412
Report Date: 07/27/2021
Date Signed: 07/27/2021 04:48:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
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: 20DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Akemie JonesTIME COMPLETED:
05:00 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 July 27, 2021 at 9:35 AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced Required 1 Year inspection for the School-Aged component. LPA met with the facility Director, Akemie Jones who guided LPA on a tour of the facility. Upon entry, LPA counted 20 School-Aged Children in care and 2 Teachers. There are two classrooms. The facility also is licensed for a Preschool program (197419411). The facility operates Monday through Saturday from 5:00 AM to 8:00 PM during summer. During the regular school year, hours extend to 5:00AM to 11:00PM. Incidental Medical Services (IMS) was discussed.

Furniture and equipment were inspected for age appropriateness and good repair. Rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings. LPA observed age appropriate toys and materials. Drinking water is available inside the classroom in the form of water dispensers and disposable cups. LPA observed staff interacting with children. Trash can has lid.

LPA inspected and observed 3 gender neutral bathrooms (6 toilets, 5 sinks). Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper, seat covers and paper towels readily available. Water temperature is appropriate.
Children are inspected for illnesses (temperature check and overall wellness check) as they arrive. A review of medication policy indicated that prescription medication is administered only with parent's written permission. The Director and other administration staff administer medication and documents the dosage, date and time onto a log. Medication is brought and locked at the center (unless parent request daily return). Medication is properly labeled and stored in its original container. Medication is kept at the center until expiration date then given to parent to discard/replace. No children use medication at the facility as of this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2021
Section Cited

1
2
3
4
5
6
7
101216 Personnel Requirement (g) All personnel... shall be... physically and mentally capable of performing assigned tasks. (1)good physical health shall be verified by a health screening... performed by or under the supervision of a physician. This requirement was not met as evidence by:
8
9
10
11
12
13
14
Based on record review, Staff 1 and Staff 2 facility files were missing the Health Screening (LIC503), which poses a potential Health and Safety Risk to children in care.
8
9
10
11
12
13
14
Type B
08/03/2021
Section Cited

1
2
3
4
5
6
7
(b) (1)... employee of a licensed child day care facility shall complete the mandated reporter training ... and shall complete renewal mandated reporter training every two years... This requirement was not as evidenced by:
8
9
10
11
12
13
14
Based on record review Staff 3 is missing a completed Mandated Reporter Training Certificate in the facility file, which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14
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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2021
Section Cited

1
2
3
4
5
6
7
(a) (1) ...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. This Requirement was not met as evidence by:
8
9
10
11
12
13
14
Based on record review, Staff 1's facility file did not contain immunization records for measles or pertussis, which poses a potential Health and Safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
VISIT DATE: 07/27/2021
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
Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. The play area has sand and concrete. The area was observed to be free of debris. There is an area for rest under canopy. Water pitcher and disposable cups are brought outside during play. Play area was inspected and found to be free of hazards and inaccessibility to bodies of water. Separate playground schedule for school-age and preschool children. Bikes and jungle gym were present and in good repair.

There is a clean fully equipped kitchen (off limits) with refrigerator, freezer, two ovens with stove top and microwave oven. The facility provides breakfast, AM snack, lunch, PM snack, and dinner. Menu is posted in the classroom, kitchen, and front office. Allergy list is posted in the kitchen and classrooms. LPA observed an appropriate amount of food and snacks, staff had just finished preparing snack. The chemicals are kept separate from the food, stored in the staff restroom.

Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Fire/earthquake drills current (conducted 6/25/21). Roster current.

Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Personal rights of children were discussed.
Children's records and staff records were reviewed. Staff are certified in Pediatric CPR and First Aid expire 10/13/2021. Based on file review, LPA observed facility file for Staff 1 missing completed Health Screening (LIC503) and immunization records. Staff 2 facility file is missing the completed Health Screening (LIC503). Staff 3 is missing the completed mandated reporter training certificate. See LIC809D for citation details. Additional forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov.

--Director advised visit www.shotsforschool.org for Immunization information.
--Director was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Child Care Centers (Disaster Planning information):https://cccld.childcarevideos.org/child-care-center-operators/disaster-planning-and-fire-safety/
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KAI'S JUSTICE CHILDCARE CENTER
FACILITY NUMBER: 197419412
VISIT DATE: 07/27/2021
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
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Director advised before an individual can work at a licensed childcare facility, they must receive a criminal record clearance or exemption from the Department’s Care Provider Management Bureau (CPMB).

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Center Director 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 (call within 24 hours and submit written report within 7 days) and on the form LIC624. Center reminded to review updates/regulations as well as quarterly updates on Department website. The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also discussed.

Type B Citations were cited during this inspection and Director was provided appeal rights.
Consultation provided during the inspection. Exit Interview conducted and a copy of report read and provided to Director, Akemie Jones
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5