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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202079
Report Date: 04/17/2025
Date Signed: 04/17/2025 11:11:11 AM

Document Has Been Signed on 04/17/2025 11:11 AM - 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:SMALL WORLD NURSERYFACILITY NUMBER:
191202079
ADMINISTRATOR/
DIRECTOR:		MILLER, LINDAFACILITY TYPE:
850
ADDRESS:26640 NORTH BOUQUET CANYON RDTELEPHONE:
(661) 296-1155
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 85TOTAL ENROLLED CHILDREN: 85CENSUS: 16DATE:
04/17/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Michelle Moyor, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On Thursday, April 17, 2025, Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management deficiencies to follow up in regards citations given on April 4, 2025, addressing rodent infestation, and met with Director Michelle Moyor who granted access and guided LPA Rivera on a tour of the facility.

LPA observed a total of 16 preschool children present with staff 1, staff 2 and staff 3 providing care and supervision in classrooms 4 and 5. LPA observed the facility to be within ratio.

LPA entered classroom 6 to inspect the cabinets, shelves, children furniture and toys. LPA observed the cabinets, shelves, children furniture and toys to be cleaned and free of dust, webs, and particles. Director Michelle stated the carpet is scheduled to be wash on Friday April 18, 2025. and children have not been using the classroom since April 7, 2025. Per director on April 12, 2025, the maintenance crew Fresh Start Cleaning, vacuumed the cabinets, cubbies, carpet and sanitized all flat surfaces, counter tops, cabinets, furniture, windowsills, and all trash cans. Staff cleaned and disinfected the toys with bleach and water mix solution.

LPA inspected the outdoor shed. Director stated an exterminator company Excel came to remove the rodent droppings, urine, carpet, toys and covered holes and gaps. The shed was also fumigated and cleaned by the exterminator company. LPA observed the shed to be free from rodent droppings, urine and opening gaps and holes closed. Excel sealed around the electrical line, replaced the vent screen, and sealed rodent entry way around conduit and placed 8 rodent traps. The traps are inaccessible to children.

LPA Rivera obtained Excel exterminator, fresh start cleaning invoices and Big Red Carpet Cleaning confirmation receipt for service dated Friday, April 18, 2025.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2025
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: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 04/17/2025
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Based on LPA Rivera observation and documentation received, the facility took action to address the rodent infestation, therefore the citations given on April 4, 2025, have been cleared.

A notice of site visit was given and must remain posted for 30 days and exit interview conducted, and report was reviewed with director Michelle Moyor.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Mayra Rivera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC809 (FAS) - (06/04)
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