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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492943
Report Date: 10/05/2021
Date Signed: 10/05/2021 04:06:14 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:KIDS TOWN CHILDCARE CENTER, LLCFACILITY NUMBER:
197492943
ADMINISTRATOR:ANA GARCIAFACILITY TYPE:
830
ADDRESS:1825 WEST AVENUE J, SUITE 125TELEPHONE:
(661) 951-2070
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:30CENSUS: 5DATE:
10/05/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Director Ana GarciaTIME COMPLETED:
04:15 PM
NARRATIVE
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On October 5, 2021 at 11:25 AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced complaint inspection on complaint control number 12-CC-20210929114049, disclosed the purpose of inspection, and was granted entry by Director Ana Garcia. LPA observed 4 napping infants and 1 napping toddler with 2 staff on association list.

At 12:25PM, LPA observed 3 infants napping in their cribs with blankets covering them as they slept. California Code of Regulations Title 22 Division 12 Chapter 1 Subchapter 02 Infant Care Centers 101439.1 Infant Care Center Sleeping Equipment Type A violation was cited. Please see LIC809D for deficiency details.

During inspection, LPA observed Director immediately removed the blankets from the cribs.

Director was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of this licensing report (LIC809) 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. A copy of the Acknowledgment of receipt of licensing report (LIC9224) was
provided and must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Director.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KIDS TOWN CHILDCARE CENTER, LLC
FACILITY NUMBER: 197492943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2021
Section Cited

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101439.1 Infant Care Sleeping Equipment (a)(f)Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidence by:
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Based on observation: 3 infants were covered by a blanket in their cribs while they slept during nap time, which poses an immediate Health and Safety Risk to children in care.
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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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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