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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411391
Report Date: 02/26/2024
Date Signed: 02/26/2024 02:38:52 PM

Document Has Been Signed on 02/26/2024 02:38 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LANCASTER UNITED METHODIST CHILDRENS CENTERFACILITY NUMBER:
197411391
ADMINISTRATOR:MEDINA, NICOLEFACILITY TYPE:
840
ADDRESS:918 W. AVE. JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 0DATE:
02/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Director Nicole MedinaTIME COMPLETED:
03:00 PM
NARRATIVE
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On 2/26/2024 at 1:07pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by Director Nicole Medina who permitted entry to the facility. LPA toured the facility with the Director according to the facility sketch. Upon arrival, LPA observed 0 children with 1 staff member ready to provide care and supervision.

During this investigation, LPA received pertinent documents related to this investigation, received written statements from relevant parties, and conducted relevant interviews. On 2/21/2024, there was an incident that involved S1, S2, C1, and C2 and other children. S1 was transporting C1, C2, and other children in the transport vehicle when S1 engaged in a conversation with S2 that made C1 feel uncomfortable. C1 approached the Director and made them aware of the situation. The Director took action and had C1 and C2 complete statements regarding the incident. The Director took immediate and corrective action on S1 and changed the children S1 can transport. The Director will follow-up and provide the correaction on S2 as part of the POC. Also, after the incident occurred on 2/21/2024 inside the school age classrooms, it was found that S2 released the door in front of C2 in between the school age classrooms.

It was found that S1 and S2 violated the personal rights of the children in the transport vehicle and that S2 violated the personal rights of C2. This is a Type B Violation, see the LIC 809D for the details.

As a result of the inspection, the facility was found to be in noncompliance with Title 22 Regulations and has been cited one Type B deficiency, see the LIC 809D for the details.

All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, and a copy of this report was read and provided to the Director along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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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Document Has Been Signed on 02/26/2024 02:38 PM - It Cannot Be Edited


Created By: Andrea Pittman On 02/26/2024 at 02:21 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: 197411391

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/11/2024
Section Cited
CCR
101223(a)(1)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
The following requirement was not met as evidenced by:
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Director will conduct a training on personal rights and classroom management and send a copy of the attendees and corrective actions on S2 for violating personal rights via e-mail no later than 3/11/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above as S1 and S2 engaged in inappropriate conversation in front of children in care and S2 treated C2 inappropriately which posed a potential health, safety or personal rights risk to persons 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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024


LIC809 (FAS) - (06/04)
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