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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492945
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:55:52 PM

Document Has Been Signed on 03/30/2022 03:55 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: 45CENSUS: 23DATE:
03/30/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana GarciaTIME COMPLETED:
11:41 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
LPA's Maddox and Tsutaoka conducted an unannounced inspection on 3/23/2022, during that inspection, a Civil Penalty was assessed for failure to correct, however, LPA's inadvertently forgot to re-cite and assign another POC date. During this inspection, LPA's are re-citing for violation of Section 101238(a) Building and Grounds, epoxy resin/glaze on the flooring is worn out throughout the School age room, There were exposed wires hanging from the ceiling due to water damaged ceiling tiles, during this inspection, these violations were not cleared and there was no request for an extension.

Director has requested an extension of this Plan of Correction date until 4/11/2022.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2022
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 03/30/2022 03:55 PM - It Cannot Be Edited


Created By: Donna Maddox On 03/30/2022 at 09:21 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: KIDS TOWN CHILDCARE CENTER, LLC
FACILITY NUMBER: 197492945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/11/2022
Section Cited
CCR
101238(a)

1
2
3
4
5
6
7
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This re-
1
2
3
4
5
6
7
Director has requested an extension to April 11, 2022.
8
9
10
11
12
13
14
quirement was not met as evidenced by: epoxy resin/glaze on the flooring is worn out throughout the School age room, There are exposed wires hanging from the ceiling due to water damaged ceiling tiles
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:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022


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