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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418426
Report Date: 09/14/2023
Date Signed: 09/14/2023 12:19:29 PM

Document Has Been Signed on 09/14/2023 12:19 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:
197418426
ADMINISTRATOR:TOLLIVER, ADRIENNEFACILITY TYPE:
830
ADDRESS:2739 W. AVENUE LTELEPHONE:
(661) 718-3614
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Adrienne TolliverTIME COMPLETED:
12:30 PM
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 9/14/2023, Licensing Program Analyst (LPA) Carol Heath met with the Director, Adrienne Tolliver, to conduct an unannounced Annual/Random inspection. LPA disclosed the purpose of the inspection and was granted entry to the facility. The facility’s old name was Kai’s Justice Learning Academy. The new name for the facility is A Place of Our Own Learning Academy, INC.
Upon arrival, LPA observed 1 infant classroom in use with a total of 5 infants. There are 2 teachers in the infant classroom. There are also preschool/Toddler option (197417593) and School age program (197417594). The hours of operation are 5 AM-8 PM Monday-Friday. Incidental Medical Services (IMS) were discussed.
Physical Plant: LPA toured and inspected 1 infant classroom. Furniture and equipment were checked for age appropriateness and good repair. The room is clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPA observed age-appropriate toys and materials. Daily activities schedule was observed in each classroom. LPA observed children's personal sheets in each cubby. Cribs used are maintained in good condition, wiped/cleaned/disinfected (daily), weekly, or when soiled, with no contact with other children's bedding. LPA observed a tight-fitted sheet in each crib.
Drinking water is available inside the classrooms in the form of disposable plastic cups and water jugs. A fire extinguisher (checked 12/20/2022), a smoke detector, and a carbon monoxide detector are on the premises.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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 16
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: 197418426
VISIT DATE: 09/14/2023
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
26
27
28
29
30
31
32
All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; they shall be leakproof and rodent-proof.
LPA inspected and observed one changing table, as well as clean diapers readily available. LPAs observed soap, toilet paper, and paper towels readily available. Water temperature is appropriate. LPA observed soap, toilet paper, and paper towels readily available.
Children are inspected for illnesses as they arrive. A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The Director and other administration staff administer medication and document the dosage, date, and time on a log. Medication is brought and locked at the center (unless the parent requests daily return). Medication is labeled correctly and stored in its original container. Medication is kept at the center until expiration and sent home with the parent for disposal. There are currently no children in infant care with IMS needs. The separate area behind the front desk will be for isolating and caring for ill children. There is a mat available for ill children. An isolated toilet and sink are available for ill children in the staff restroom.
A Fire Drill/Earthquake log is posted in the office. The center conducted disaster drills for at least 6 months (8/18/23). A current Roster is available.
Transportation arrangement: Not for infant and preschool program. Only for school age children.
Lead Testing: According to the director, the center will need to make an appointment for drinking water tested for lead contamination levels.
The outdoor: Per the director, the infants usually stay in the center and do not have an outdoor play area.
LPA observed a first aid kit. LPA provided a First aid supplies list to the Director.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 16
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: 197418426
VISIT DATE: 09/14/2023
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
26
27
28
29
30
31
32
Food Service: There is a clean, fully equipped kitchen with refrigerator/freezer and microwave. The facility currently has a food program. Meals such as breakfast, lunch, snacks, and dinner are provided. LPA also observed a refrigerator in the infants' classroom for infants' formula and feeding bottles.
The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Sign-in and out sheets were reviewed. The Teacher-to-child ratio was observed, and staff names were recorded. Care and supervision were evaluated to determine if the children’s basic needs were met and appropriate.
Staff Records/ Children Records: Staff and Children's records were reviewed. LPA observed 4 staff files (2 infant teachers, director and office assistant ). LPA verified there is at least 1 staff person present with current CPR and First Aid Training. 1 staff complete the Mandated Reporter training every 2 years. 3 other staff will need to complete the Mandated Reporter Training. 2 staff do not have Measles, Pertussis, and Influenza vaccination in the file. 2 staff’s (Infant assistant and office assistant ) fingerprinting does not associated with the infant facility.
LPA reviewed 5 children's records, complete with the parent’s signature. The sleeping log is located in the infant room. The last time the staff documented the infant sleeping was on 9/11/2023. LPA observed an infant was sleeping during the inspection without the sleeping log. In children, LPA did not see old sleeping log in the infant’s files. 4 infants does not have LIC 701 Physician’s Report and TB Risk Assessment.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 3 of 16
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: 197418426
VISIT DATE: 09/14/2023
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
26
27
28
29
30
31
32
The following general information was discussed during this inspection:
· For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Center does not provide IMS at this time.
· As of January 1, 2018, childcare providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided according to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
· §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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 4 of 16
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: 197418426
VISIT DATE: 09/14/2023
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
26
27
28
29
30
31
32
· California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep
· 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
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of the report documenting a Type A Citation and sign form LIC 9224 acknowledging receipt. Staff is aware of the required forms for children's files and forms that shall be posted after licensure.
· Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements: 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 5 of 16
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: 197418426
VISIT DATE: 09/14/2023
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
26
27
28
29
30
31
32
· 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 about exemptions and Parent’s Rights was also discussed.

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

Exit interview conducted and report was reviewed with the Director, Adrienne Tolliver.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 6 of 16
Document Has Been Signed on 09/14/2023 12:19 PM - It Cannot Be Edited


Created By: Carol Heath On 09/14/2023 at 11:33 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: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197418426

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview,record review, the licensee did not comply with the section cited above. According to the Director the facility will make the appointment by next Monday (9/18/2023), which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2023
Plan of Correction
1
2
3
4
The director will make an appointment and email LPA the testing date.
Type B
Section Cited
CCR
101416.2(d)
Infant Care Teacher Qualifications and Duties
(d) A photocopy of each teacher's transcript(s) documenting successful completion of required course work shall be maintained at the center.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation,interview, record review, the licensee did not comply with the section cited above. LPA was unable to find the transcirpt record, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/21/2023
Plan of Correction
1
2
3
4
The director will email the infant teacher's transcript to LPA by 9/21/23
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:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


LIC809 (FAS) - (06/04)
Page: 7 of 16
Document Has Been Signed on 09/14/2023 12:19 PM - It Cannot Be Edited


Created By: Carol Heath On 09/14/2023 at 11:33 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: A PLACE OF OUR OWN LEARNING ACADEMY,INC
FACILITY NUMBER: 197418426

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, record review, the licensee did not comply with the section cited above. LPA observed 4 staff files and only 2 staff have the mandated reporter training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
The director and the infant assistant will complete the training. The director will email the certification to LPA by the due date.
Type B
Section Cited
CCR
101220(b)(2)
Child's Medical Assessments
(b) The medical assessment shall provide the following: (2) Results of a test for tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation,interview,record review, the licensee did not comply with the section cited above, LPA observed 5 children's file only one children has TB risk assessment. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/28/2023
Plan of Correction
1
2
3
4
The director will print out LIC 701 Physician's Report and give it parent to go to the doctor.
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:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023


LIC809 (FAS) - (06/04)
Page: 8 of 16