<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411391
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:06:09 PM

Document Has Been Signed on 12/23/2024 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LANCASTER UNITED METHODIST CHILDRENS CENTERFACILITY NUMBER:
197411391
ADMINISTRATOR/
DIRECTOR:		MEDINA, NICOLEFACILITY TYPE:
840
ADDRESS:918 W. AVE. JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 4DATE:
12/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Assistant Director Aja MintersTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/23/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Assistant Director Aja Minters according to the facility sketch. Upon arrival, LPA observed 4 children present with 3 staff members providing care and supervision.

During this inspection, LPA conducted a followed up on the UIR that was received on 7/3/2024 about an incident that involved Child 1 and Staff 2. LPA interviewed staff, school age children, parents, and other relevant parties regarding the incident. The investigation revealed the following information:

Child 1 had a disagreement with Staff 2 in the school age classroom. Child 1 left the school age classroom without permission to go to see Staff 1. Staff 1 was having a conversation with a parent and did not immediately respond to Child 1. Staff 2 approached Child 1 while they waited to speak to Staff 1 and requested Child 1 to return to the classroom. As Child 1 was returned to the classroom, there was disciplinary physical contact made by Staff 2 on Child 1. The facility took action to suspend, then terminate Staff 2 based on the actions taken by Staff 2. Based on the obtainable evidence, Child 1 did not obtain any injuries during the incident with Staff 2. After the review of the obtained evidence during the investigation, it was determined that the personal rights of Child 1 were violated by Staff 2, this is a Type B violation, 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 Assistant Director along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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 2
Document Has Been Signed on 12/23/2024 03:06 PM - It Cannot Be Edited


Created By: Andrea Pittman On 12/23/2024 at 11:18 AM
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: 12/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/06/2025
Section Cited
CCR
101223(a)(3)

1
2
3
4
5
6
7
101223 Personal Right (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment…
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director will complete a training and send proof of the training via email no later than 1/6/2025.
8
9
10
11
12
13
14
Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above when Staff 2 used physical contact to discipline Child 1 which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 12/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/23/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2