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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492945
Report Date: 01/04/2022
Date Signed: 01/04/2022 02:30:35 PM

Document Has Been Signed on 01/04/2022 02:30 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:KIDS TOWN CHILDCARE CENTER, LLCFACILITY NUMBER:
197492945
ADMINISTRATOR:ANA GARCIAFACILITY TYPE:
840
ADDRESS:1825 WEST AVENUE J, SUITE 125TELEPHONE:
(661) 951-2070
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 45TOTAL ENROLLED CHILDREN: 30CENSUS: 15DATE:
01/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Ana Garcia and Jessica DonisTIME COMPLETED:
02:45 PM
NARRATIVE
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On January 4, 2022 at 10:10AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced Case Management - Incident inspection regarding the self disclosed wandering away incident that occurred 12/29/2021. Facility staff notified Licensing by phone and submitted the required Unusual Incident Report (LIC624) in the required time frame as set forth by the regulations. LPA disclosed the purpose of the inspection and was granted entry by Director, Ana Garcia. Upon entry, LPA counted 15 children in care.

During inspection, LPA interviewed children, staff, and obtained facility roster. On 12/29/21 at approximately 2:00PM, Child 1 and Child 2, siblings, were play fighting. Staff 2 told them both to settle down and fighting is not a way they play in the facility. Once both children calmed down, Child 2 kicked Child 1 in his private area which caused him to become very upset. Child 1 then got up to fight Child 2, causing Staff 1 to get between them. Child 1 hit Staff 1 and Child 2, then ran out, exiting the school age classroom from the gate then exiting the facility from the door closest to the school age room. Staff 2 called Assistant Director (AD) on the walkie talkie to inform her Child 1 ran out. Staff 3 observed Child 1 exit and called out to AD to state Child 1 ran out.

AD ran outside to catch up to Child 1, who was standing directly outside and addressed Child 1, asking what had happened. At that time, Child 1's consulate called and AD stated she was happy the consulate called because they were in the middle of an incident. This upset Child 1, who began to run off. AD ended the call with the consulate and chased after Child 1, but Child 1 outran AD and hid, causing her to lose sight of him. AD lost Child 1 approximately 896.4 feet from the facility. AD then called consulate to seek guidance on next steps, who instructed her to contact the Sheriff's Department.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2022
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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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: KIDS TOWN CHILDCARE CENTER, LLC
FACILITY NUMBER: 197492945
VISIT DATE: 01/04/2022
NARRATIVE
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At approximately 2:15PM, AD contacted the Sheriff's Department to notify them of the child wandering away. AD was instructed to return to the center. At approximately 3:00PM, Child 1 returned to the facility with the Sheriff. The Sheriff did not disclose to facility staff where Child 1 was found.

Based on information gathered during the investigation, it does appear a violation of Title 22 Regulations occurred when Child 1 exited the facility, ran from facility staff, and facility staff lost sight of him, requiring law enforcement to intervene and locate Child 1.

California Code of Regulations, Title 22, Division 12 101229 Responsibility for Providing Care and Supervision Type A deficiency was cited during this inspection. Please see LIC809D for deficiency details. An immediate $500 civil penalty has been assessed as a result of Lack of Care and Supervision.

Assistant Director 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 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 and a copy of the Acknowledgment of receipt of licensing report (LIC9224) must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit were provided to Assistant Director.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/04/2022 02:30 PM - It Cannot Be Edited


Created By: Brigitte Tsutaoka On 01/04/2022 at 01:17 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: KIDS TOWN CHILDCARE CENTER, LLC
FACILITY NUMBER: 197492945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/05/2022
Section Cited
CCR
101229(a)(1)

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101229 Responsiblity to Provide Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time,...Supervision shall include visual observation. This requirement was not met as evidence by:
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Facility agreed to create a plan to prevent children from exiting the facility, including plan to install doors with child safety locks, no later than 1/05/2021. Assistant Director has begun contacting the fire department to get approvals for safe door installation
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Based on interview and record review, facility staff failed to prevent Child 1 from exiting the facility and running away, requiring contact of the Sheriff's Department to search for and find Child 1, which causes an immediate Health and Safety Risk to children in care.
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that adheres to fire marshal requirements.

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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:Carissa Bell
LICENSING EVALUATOR NAME:Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2022


LIC809 (FAS) - (06/04)
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