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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411390
Report Date: 08/24/2021
Date Signed: 08/24/2021 03:06:02 PM

Document Has Been Signed on 08/24/2021 03:06 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LANCASTER UNITED METHODIST CHILDRENS CENTERFACILITY NUMBER:
197411390
ADMINISTRATOR:DAMON, TAMMYFACILITY TYPE:
830
ADDRESS:918 W. AVE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
08/24/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Dayna RodriguezTIME COMPLETED:
03:20 PM
NARRATIVE
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On 08/24/21, Licensing Program Analysts (LPA's) Dorsey and Ibitoye conducted an initial 10 day inspection for a complaint posed against the pre-school component (#191201899). LPA's disclosed the purpose of the inspection and was granted entry by Treasurer, Dayna Rodriguez who guided LPA on a tour of the facility.

During the 10-day visit on 08/24/21, LPA Dorsey and Ibitoye found through interview that the complaint received 08/20/21 for preschool license (#191201899) involved a child in the infant program. LPA's inspected both infant classrooms. Per Treasurer one of the classroom is the infant classrooms (0-1 years of age) and the other class is the toddlers classroom (1-2 years of age). While inspecting the infant classroom LPA's observed a child sleeping in a crib with a blanket. LPA's discussed the Safe Sleep regulations with the Treasurer and she said she will take all blankets out of the classroom. LPA's observed all blankets were removed from the cribs. While LPA's toured the Toddlers classroom LPA's observed Staff #1 with 4 infants and 2 toddlers making the classroom out of ratio. During the visit LPA's observed Staff #2 go into the Toddlers classroom to put it back into ratio.

Licensee 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 a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) 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 when a serious deficiency, Type A, is cited (LIC9224).

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Treasurer Rodriguez and Director Tammy Damon.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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 3
Document Has Been Signed on 08/24/2021 03:06 PM - It Cannot Be Edited


Created By: Justin Dorsey On 08/24/2021 at 02:18 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: LANCASTER UNITED METHODIST CHILDRENS CENTER
FACILITY NUMBER: 197411390

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2021
Section Cited
CCR
101416.5(b)

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101416.5 Staff-Infant Ratio (b)There shall be a ratio of one teacher for every four infants in attendance. This requirement is not met as evidenced by:
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Per Treasurer and Director they will send LPA's a copy of a staff sign-in/out sheet for the toddlers classroom by POC due date 08/31/21.
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Based on observation Staff #1 in a classroom with 4 infants and 2 toddlers by themself, which poses a immediate Health, Safety or Personal Rights 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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/24/2021 03:06 PM - It Cannot Be Edited


Created By: Justin Dorsey On 08/24/2021 at 02:34 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: LANCASTER UNITED METHODIST CHILDRENS CENTER
FACILITY NUMBER: 197411390

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2021
Section Cited
CCR
101439.1(f)

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101439 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement is not met as evidenced by:
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Per Director and Treasurer she will not allow infants to sleep with blankets by POC due date 08/31/21.
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Based on observation a child was sleeping in a crib with a blanket, which poses a potential Health, Safety or Personal Rights 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:Claretta Yates
LICENSING EVALUATOR NAME:Justin Dorsey
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


LIC809 (FAS) - (06/04)
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