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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364819494
Report Date: 06/23/2025
Date Signed: 06/23/2025 05:24:31 PM

Document Has Been Signed on 06/23/2025 05:24 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KIDS DISCOVERY WORLDFACILITY NUMBER:
364819494
ADMINISTRATOR/
DIRECTOR:		MALKANTHI FERNANDOFACILITY TYPE:
830
ADDRESS:15858 BEAR VALLEY ROADTELEPHONE:
(760) 241-2416
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
06/23/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:11 PM
MET WITH:MALKANTHI FERNANDO, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 6/23/25, Licensing Program Analyst (LPA) Crystal Ali met with Licensee, for the purpose of an unannounced Annual/Random inspection. LPA disclosed the purpose of the inspection and was granted entry to the facility. Upon arrival, teacher/child ratios were observed in compliance. LPA observed 6 children and 2 teachers, present during this inspection. Infant room consist of one classroom and one small play yard area. The facility hours of operation are from 6:15 am to 6:30 pm, Monday-Friday. Incidental Medical Services (IMS) were discussed. There are no current children with IMS. Licensee states there is no weapons or smoking the premises.

Staffing Ration and Capacity: Care and supervision were evaluated to determine if the infant’s basic needs were met and appropriate. Sign-in and out sheets were reviewed. LPA observed 6 infants and two teachers in the infant classroom.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
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Physical Plant: LPA toured and inspected the infant classroom. Furniture and equipment were checked for age appropriateness and good repair. The classroom is clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for infant's belongings labeled with their names. Facility has a surveillance system on the premises. LPA observed age-appropriate toys and materials, five cribs, 8 highchairs for feeding, and refrigerator for baby bottles. Daily activities schedule was observed on the parent board next to classroom door. Drinking water is available inside the classrooms in the form of bottles or sippy cups. Parents provide the infants formula and bottles. All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; they shall be leakproof and rodent-proof. LPA observed trash cans in classroom, kitchen and play yard to all have lids. LPA observed the smell of an odd odor near the staff bathroom. LPA brought it to Licensee attention. Both LPA and Licensee could smell the odor. Licensee stated that she will look into the odor and retrain her employee on unwanted odors and smells in the facility and update the employee handbook. LPA observed the area where the odor was coming from to be inaccessible to children at the facility. LPA observed no immediate threat or risk to the children. LPA cited a technical violation for the odor.

Napping: Per Licensee, children do takes naps, and staff are utilizing infant sleep logs. LPA observed cribs (5) and mats (5) for napping.

Bathroom: LPA inspected and observed one staff bathroom that also houses facility chemicals. The bathroom has a lock however, it is still easy to access. LPA recommend for licensee to place a safety latch at the top of the door. LPA observed soap, toilet paper, and paper towels readily available. In the infant room the changing station is located to the left of the sink on the counter.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
NARRATIVE
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Medication: Infants are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The staff will administer medication and document the dosage, date, and time on a log. Medication is brought and safety latched at the center (unless the parent requests daily return). Medication is labeled correctly and stored in its original container. Medication is kept at the administration office until expiration and sent home with the parent for disposal. There are currently no children in care with IMS needs. Infants are isolated when ill by placing them in crib away from other infants until parents arrive to pick them up.
Lead Water Testing: Lead water testing as completed and approved on 10/28/22. LPA observed these results during annual inspection.
The Outdoor: The play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. The outdoor play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. LPA observed four walking toys that are prohibited by licensing. Licensee removed the items immediately. The play area has a small playhouse and several other toys. The play area was inspected and found to be free of hazards and inaccessibility to bodies of water. The facility has a separate fenced playground yard for school-age and preschool children.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
NARRATIVE
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Fire Extinguisher: Fire/earthquake drills are current and completed every 6 months. Last fire drill completed on 2/13/25. A fire extinguisher is in the green (service last checked 10/7/24), inaccessible to children mounted on the wall near front entrance of facility. Smoke detector, and a carbon monoxide detector are on the premises and in compliance with fire marshal standards. Licensee informed LPA that the fire marshal came to the facility two weeks ago and informed her that they need a knox box. LPA observed the knox box that licensee will have installed and then fire marshal will return to sign off on the inspection approval. LPA requested for licensee to send copy of approval letter to place in the facility file at PRO office. LPA observed a first aid kit located in the administrative office inaccessible to children.
Transportation: The facility does not provide transportation for infant’s children.
Staff/ Children Records: LPA reviewed with licensee the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Staff and infant’s records were reviewed. LPA reviewed 2 children's records and 3 staff records. LPA verified there is at least 1 staff person present with current CPR and First Aid Training. LPA did not observe LIC 9040 to be current. LPA observed staff files to not be in compliance. S1-S3 are all missing mandated reporter training. S2 is not fingerprint cleared in Guardian. LPA informed Licensee immediately. S2 was removed from the facility until fingerprints have cleared in Guardian. S1 and S2 are missing TB results. S2 and S3 are missing LIC 503. LPA observed child files to not be in compliance. C1 and C2 are missing complete LIC 9227 signed by parent, and needs and service plans not current (due every 4 months).
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
NARRATIVE
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Kitchen/Food Service: There is a clean, fully equipped kitchen (off limits) with a refrigerator, freezer, stove, and microwave oven. The facility provides breakfast, snack, and lunch. For infant’s licensee states parents bring the formula and snacks for children. However, facility does have milk and snacks on stock for infants if parents forget to bring their food. Allergy lists are posted in the kitchen. LPA observed an appropriate amount of food and snacks and staff preparing lunch (with gloves). The chemicals are kept separate from the food (under the sink and in staff bathroom safety latches and locked inaccessible in classroom). LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. Menus are posted at least one week in advance and made available for review by the parents. The facility does not participate in the food program.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Criminal Record Clearance - Child Care Centers
Licensee was reminded that all adults 18 and over, including
employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
NARRATIVE
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Lead Testing – Child Care Centers (CCC)
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.
Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility
of the importance of checking for recalled infant devices on the United States
Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494
VISIT DATE: 06/23/2025
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Incidental Medical Services (IMS) - Child Care Centers
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
PIN 22-05-CCP.
MyChildCarePlan.org – Child Care Centers
Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Subscribe to CCLD important information - Child Care Centers
Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.
Deficiencies: (see LIC 809D) One Type A and Four Type B deficiencies were cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

Exit interview conducted and report was reviewed with the Licensee, Malkanthi Fernando.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025
LIC809 (FAS) - (06/04)
Page: 8 of 15
Document Has Been Signed on 06/23/2025 05:24 PM - It Cannot Be Edited


Created By: Crystal Ali On 06/23/2025 at 04:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above not having criminal record clearance for S2 which poses an immediate health, safety or personal rights risk to persons in care. S2 can not be on premises until LPA Ali confirms clearance in Guardian.
POC Due Date: 06/24/2025
Plan of Correction
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2
3
4
Licensee states she will have S2 complete her fingerprint today and will notify LPA once it is completed. Once completed LPA can then check Guardian to ensure S2 has cleared.
Section Cited
Deficient Practice Statement
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2
3
4
POC Due Date:
Plan of Correction
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2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Crystal Ali
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2025


LIC809 (FAS) - (06/04)
Page: 9 of 15
Document Has Been Signed on 06/23/2025 05:24 PM - It Cannot Be Edited


Created By: Crystal Ali On 06/23/2025 at 04:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above in S1 is missing TB results; S2 is missing TB results, immunization's, and LIC 503; S3 is missing LIC 503 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2025
Plan of Correction
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2
3
4
Licensee states she will have employees complete their TB, Immunization's, and LIC 503 and will email proof of completion to LPA.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
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4
Based on observation, interview, record review, the licensee did not comply with the section cited above by not providing evidence of mandated reporter certification training completion which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2025
Plan of Correction
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2
3
4
Licensee states she will provide proof of all three staff mandated reporter training completion by 6/26/25.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Crystal Ali
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2025


LIC809 (FAS) - (06/04)
Page: 10 of 15
Document Has Been Signed on 06/23/2025 05:24 PM - It Cannot Be Edited


Created By: Crystal Ali On 06/23/2025 at 04:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KIDS DISCOVERY WORLD
FACILITY NUMBER: 364819494

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above by not having the LIC 9227 current and missing authorized representative signature for C1 and C2 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/26/2025
Plan of Correction
1
2
3
4
Licensee stated she will have both parents sign the form and will provide proof of completion to LPA via email.
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, record review, the licensee did not comply with the section cited above by not updating C1 and C2 infant needs and service plan every quarter, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2025
Plan of Correction
1
2
3
4
Licensee states that she will have infants needs and service plans completed and signed by parents. Licensee will provide proof of completion to LPA via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Crystal Ali
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2025


LIC809 (FAS) - (06/04)
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