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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191202079
Report Date: 03/30/2023
Date Signed: 01/23/2024 12:57:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2023 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20230301101818
FACILITY NAME:SMALL WORLD NURSERYFACILITY NUMBER:
191202079
ADMINISTRATOR:MILLER, LINDAFACILITY TYPE:
850
ADDRESS:26640 NORTH BOUQUET CANYON RDTELEPHONE:
(661) 296-1155
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:85CENSUS: 16DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Michelle MoyerTIME COMPLETED:
01:59 PM
ALLEGATION(S):
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Allegation #1: Physical plant- Facility has mold
INVESTIGATION FINDINGS:
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On 3/30/2023 Licensing Program Analyst (LPA) Isabel Ortega arrived at the facility for the purposes of delivering the findings regarding the above allegation. LPA Ortega met with Director, Michelle Moyer. At the time of arrival LPA observed 18 children and 3 staff proving care and supervision.
During this investigation, LPA observed classroom #6 closed and a closure note on the front of the door. Facility performed mold test(expanded fungal report provided) in three different areas including room #6 on 3/01/2023. The analyzed results provided by Pro Environmental Testing have determined no mold was detected at this time. Parents and staff were informed Room #6 has been temporarily closed until carpet is replaced and room is ready and meeting Title 22 regulations.
Based on the interviews conducted, information provided and observations, the allegation above regarding physical plant: facility has mold is deemed Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged allegation occurred. No deficiencies were cited during this inspection. Exit interview was conducted and a copy of this report, appeal rights were given to the Director.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2023 and conducted by Evaluator Isabel Ortega
PUBLIC
COMPLAINT CONTROL NUMBER: 12-CC-20230301101818

FACILITY NAME:SMALL WORLD NURSERYFACILITY NUMBER:
191202079
ADMINISTRATOR:MILLER, LINDAFACILITY TYPE:
850
ADDRESS:26640 NORTH BOUQUET CANYON RDTELEPHONE:
(661) 296-1155
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:85CENSUS: 16DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Michelle MoyerTIME COMPLETED:
01:59 PM
ALLEGATION(S):
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Facility's physical plant room #6 was damaged by the water and an odor was detected while day care children and staff were present
INVESTIGATION FINDINGS:
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Report dated 3/30/2023 is being amended ***On 3/30/2023, Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced complaint inspection to deliver findings on the above allegation. LPA met with Director, Michelle Moyer and toured the facility. Upon arrival LPA observed 16 children and three staff proving care and supervision.
During the course of the investigation, LPA conducted interviews with staff, children, and parents. LPA gathered relevant information related to the complaint. Interviews and documentation related to the incident disclosed the carpet was wet which caused an odor exceeding to room 6 and room 5. There is a restroom between the classrooms which was utilized by the children in room 5 and an odor was detected until carpet was removed and room was ventilated by fans within a couple of days. Although, the carpet was removed during the same week, the children and staff in room 5 were exposed to the odor. This posed a potential risk to the health and safety of children enrolled. Based on evidence obtained and interviews conducted, the allegation is deemed Substantiated. Facility was cited a Type B under physical plant. Please see deficiency(D)page.
Facility shall post the Notice of site visit for 30 consecutive days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 12-CC-20230301101818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2023
Section Cited
CCR
101238(a)
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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met...
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Facility has removed the carpet and is working towards replacing the carpet to meet a safe, sanitary and comfortable environment for children. Facility is working with a contractor to correct this matter. Facilty will continue to update parents and staff regarding progress and will notify the Palmdale Regional Office once the work is completed by due date. Facility will email pictures and notify LPA.
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by interviews conducted and supporting relevant documentation. The Carpet in Classroom 6 was wet and the dry walls are moist causing an unpleasant odor while children and staff were present in room 5. This poses a potential 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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
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