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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417593
Report Date: 06/17/2025
Date Signed: 06/17/2025 04:31:10 PM

Document Has Been Signed on 06/17/2025 04:31 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:A PLACE OF OUR OWN LEARNING ACADEMY,INCFACILITY NUMBER:
197417593
ADMINISTRATOR/
DIRECTOR:		ADAMS, ALLEAFACILITY TYPE:
850
ADDRESS:2739 W. AVENUE LTELEPHONE:
(661) 718-3614
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 77TOTAL ENROLLED CHILDREN: 21CENSUS: 9DATE:
06/17/2025
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:06 PM
MET WITH:Director, Adrienne Tolliver. TIME VISIT/
INSPECTION COMPLETED:
04:38 PM
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On June 17, 2025, Licensing Program Analyst (LPA) Carol Heath met with the facility Director, Adrienne Tolliver, for a required inspection of the preschool license following the facility sketch. A tour of the facility was conducted. Upon arrival, LPA observed three preschool children in the classroom. There were three teachers in the premises with 9 preschool children. When LPA arrived at the facility, the director was not on site. The hours of operation are 5:00 AM - 8:00 PM, Monday through Saturday. Incidental Medical Services (IMS) were discussed.
Indoor/Children’s Area:
There are three preschool classrooms. During today’s visit, only one classroom is being used. The childcare center is clean and in good repair. All outdoor and indoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are kept free of obstructions. The floors of all rooms have a safe and clean surface.
During today's inspection, LPA observed the laundry room was not closed and locked. A Cortizone-10 medication was in the T-K classroom on top of the children's cubby.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
NARRATIVE
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The furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labeled with name) for his/her clothing, personal belongings and or bedding (stored separately). There is a working telephone.
Drinking water is readily available indoors and outdoors (Drinking water is available inside the classrooms in the form of filtered water with disposable cups). LPA observed a sufficient quantity of cots available for napping preschool children. There is no fireplace. The center has an internal fire system and Fire Extinguisher (3A40BC, 1/8/2024).
Restrooms: LPA inspected and observed 6 toilets and 4 sinks. LPA observed that soap, toilet paper, and paper towels were readily available. Water temperature is appropriate. There is an isolation area in the therapy room for children who become ill while in care. The facility maintains a comfortable temperature at all times, and first aid supplies (See Title 22, 101226) are available. Sign-in/out sheets are also completed on a daily basis. Smoking is prohibited on the premises. Daily inspections are required for illness. No prohibited childcare items are allowed. Firearms/weapons are not allowed or stored on the premises. There is no body of water on the premises.
Napping: LPA observed children's sheets in each cubby. Cots are used and maintained in good condition, wiped/cleaned/disinfected (daily) weekly or when soiled, with no contact with other children's bedding.
Outdoor: The facility features a separate playground area for preschool children, located away from the school-age children. There are three areas where preschool children play.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
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The outside play area is completely fenced. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There are concrete areas for active play. The area was observed to be free of debris from hazards, holes, broken items, cushioning material, and any other loose items underneath. No bodies of water were observed. There are areas for shade and rest. Teacher-child ratios were observed, and staff names were recorded. Care and supervision were evaluated to determine whether the basic needs of the children were met and whether the care was appropriate.
Health-Related Services: LPA discussed the Title 22 regulation regarding Medications. All Medications need to make them inaccessible to children; all prescription and non-prescription medications have the child’s name and are dated; written consent and instruction from the child’s representative, a plan to document and report to the child’s representative when medication is administered to a child; IMS plan on file (if applicable).
Children are inspected for illnesses (as per our wellness policy) upon arrival. A review of medication policy indicated that prescription medication is administered only with the parent's written permission (using the licensing medication form—LIC9221). LPA advised the Director to administer medication and document the dosage, date, and time on a log. The parent can bring and take medication home daily. Medication will be appropriately labeled and stored in its original container.
Staff/Personnel Records: The director's (qualified) qualifications were verified, the Designation of Responsibility was observed, immunizations, TB clearance, health screening, criminal record statement, a statement acknowledging suspected child abuse, and a mandated reporter were observed in the file.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
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Upon review of staff files, it was found that Teacher #1 did not have fingerprint clearance and was not associated with the facility or the preschool program (license #197417593). Teacher #2 was associated with the facility but not with the preschool program; she is currently associated with the infant program (license #197418426). Additionally, Teacher #2 was able to provide proof of immunization against measles. As a result, the facility has been issued a Type A Citation. An immediate civil penalty of $500 was assessed for Teacher #1, and $100 for Teacher #2, due to caregiver background check violations.
Facility Records: The roster fire/disaster drill log will be submitted to the LPA by next Friday. We also reviewed CPR/First Aid and mandated report training.
Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, and earthquake preparedness checklist.
Documents Provided and Discussed: Forms and records will be kept at the facility and IMS.
Electrical outlets are inaccessible and recalled, and prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children.
It currently has a food program that provides breakfast, lunch, snacks, and dinner. LPA observed the kitchen and advised the facility to label the food and document the temperatures of the refrigerator and freezer every morning.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
NARRATIVE
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The following general information was discussed during this inspection:

Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
*All Licensing reports are available for review online and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.
Fingerprint clearances and transfers: Before working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state-licensed facility to another using form LIC 9184
**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children
**The Center Director advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations and quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation with regard to exemptions and parents' rights was also discussed.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
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Criminal Record Clearance - Child Care Centers Licensee [or facility representative] was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593
VISIT DATE: 06/17/2025
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Incidental Medical Services (IMS) - THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Notice of Site Visit - Centers and Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.


Deficiencies cited: (See LIC 809D). The following Type A and Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.


Exit interview conducted and report was reviewed with Director, Adrienne Tolliver, along with her appeal rights and Notice of Site Visit.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Carol Heath
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/17/2025 04:31 PM - It Cannot Be Edited


Created By: Carol Heath On 06/17/2025 at 03:52 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: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101226(e)(1)(A)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (A) Medications shall be kept in a safe place inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above. During today's inspection, LPA observed the laundry room was not closed and locked. A Cortizone-10 medication was in the T-K classroom on top of the children's cubby, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2025
Plan of Correction
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LPA gave the Medication to the Director and asked the Director to provide training to her staff.
The director will email the meeting agenda and staff signature.
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above. Teacher #1 did not have fingerprint clearance and was not associated with the facility or the preschool program (license #197417593). Teacher #2 was associated with the facility but not with the preschool program; she is currently associated with the infant program (license #197418426). which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/17/2025
Plan of Correction
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The director called the owner and associated both teachers to the facility (Ave L) and Preschool program ( #197417594).
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Carol Heath
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/17/2025 04:31 PM - It Cannot Be Edited


Created By: Carol Heath On 06/17/2025 at 03:52 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: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197417593

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. During today's visit, there is a teacher unable to provider her MMR and Dtap shot record,which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2025
Plan of Correction
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The director talked to the staff. The staff will make an appointment and submit the shot record by 6/24/2025
Type B
Section Cited
HSC
1596.799(c)
General Provisions and Definitions
(c) Upon admission of a child into a drop-in childcare center, the child’s authorized representative shall sign an acknowledgment that they understand that verification of immunizations and tuberculosis testing is not required for any child accepted into a drop-in childcare center.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. During today's visit, LPA reviewed 5 children files and only 2 children have TB risk assessments, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/30/2025
Plan of Correction
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The direcor will review the file and make sure all the children have TB risk assessment in file.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Claretta Yates
NAME OF LICENSING PROGRAM MANAGER:
Carol Heath
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2025


LIC809 (FAS) - (06/04)
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