197493008-1-2-2026-12-CC-KCAY-DGVT2B-20250521142028

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493008
Report Date: 05/21/2025
Date Signed: 01/02/2026 04:55:46 PM

Document Has Been Signed on 01/02/2026 04:55 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	MAGIC CAROUSEL MONTESSORI PRESCHOOL		FACILITY NUMBER:	197493008
ADMINISTRATOR/ DIRECTOR:	SHIRLEY JOHNSON		FACILITY TYPE:	830
ADDRESS:	17956 SIERRA HIGHWAY		TELEPHONE:	(661) 298-4065
CITY:	CANYON COUNTRY	STATE: CA	ZIP CODE:	91351
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 8	DATE:	05/21/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:51 PM
MET WITH:	Josephine Shirley Johnson		TIME VISIT/ INSPECTION COMPLETED:	02:20 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	THIS REPORT WAS AMENDED FROM REPORT DATED 5/21/2025 TO SIGN AND CORRECT THE LIC 809D PAGE On May 21, 2025, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the above facility for the purpose of conducting an Annual Random inspection. LPA met with facility representative who granted access. LPA and representative toured the facility inside and outside. LPA observed eight (8) infants in total. Seven were in active play and one infant was napping with three staff. The facility operates from 6:00 am to 6:00 pm. Monday-Friday. All employees have a Criminal Record Clearance (DOJ/FBI) and Child Abuse Index Clearance and are associated to the facility. Physical Plant: There is one clean and safe classroom, the telephone service, heating, ventilation, and lighting are adequate. There are cubbies for children's belongings that are labeled with the children’s names in each classroom. The furniture, books, equipment, toys, and materials were age appropriate. The napping equipment are cribs. LPA observed five cribs and seven highchairs and there was enough for all children. The bedding is stored separately and per representative, the bedding is washed weekly and if soiled sent home daily. There was a changing table for the children and parents supply the diapers for the children.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
	VISIT DATE: 05/21/2025

NARRATIVE

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First Aid Kits were observed in each classroom in a backpack inside the cabinet. There is an Emergency Survival Kit kept in the classrooms secured in a back pack and one in the front lobby. Per representative, the fire extinguisher, smoke detector and carbon monoxide detector are operable. Trash cans have secure lids. Per representative, the carpets are cleaned once a month.
Bathrooms: There is one toilet, and two hand washing sinks hat are functioning properly and age appropriate. LPA did not observe and hazards. There was soap, toilet paper, and paper towels readily available. The staff restrooms are in the hallway outside of the classroom in the front lobby.
Kitchen: There is a kitchen with refrigerator, freezer. The facility provides breakfast, lunch, and afternoon snacks. The menus posted inside the classroom was for April. Per representative, they did not change the menu on the wall, but it is near in the sign in sheet for the parents. There is a confidential allergy list posted on the wall. LPA observed an appropriate amount of food and snacks. Bottles are made as needed; LPA did not observe any bottles in the refrigerator but there was a space labeled in the refrigerator for each infants bottle. LPA observed whole milk and Lactaid milk. Per representative, they normally use the whole milk for infants that can drink the milk transitioning from formula.
Outside: Outdoor play equipment was inspected for health, safety, cushioning material, good repair and is age appropriate. LPA observed a small play structure anchored in the ground with a canopy for shade and artificial grass as a cushioned surface, toys and small bikes and two Little Tikes slides, and three small chairs for sitting. There is a concrete walkway. The playground was observed to be free of debris. Drinking water is available in the form of a portable water jug and disposable and labeled cups.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
	VISIT DATE: 05/21/2025

NARRATIVE

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Per representative, there are no bodies of water on the premises. LPA did not observe any bodies of water. The fencing is chain linked observed locked and with security screen obstructing view into the play yard it was secure around the entire playground. Other: Children and staff files were reviewed. All the infants in care have LIC 9227 form in their files and napping log. One staff did not have the required immunization records, and one staff did not have required infant class. Current Pediatric CPR and First Aid (expires 4/2027). Transportation is not provided. Disaster Drills: Fire Drill was conducted: 3/27/25 Earthquake drill was conducted: 4/29/25. The Child/Parent Roster was complete with all required information. The Staff/Child ratios were observed to be compliant; the sign in/out sheets were paper and legible. Per representative, the children are inspected for illnesses as they arrive. There is a separate area for isolation and care of ill children in the lobby at a small table with chairs on the right until the parent can pick up the child. Per representative, the medications are stored inside the classroom locked. A review of medication policy indicated that prescription medication is administered only with parent's written permission. The management staff administers medication and documents the dosage, date, and time onto a log. Medication is stored in the classroom and kept locked. Medication is properly labeled and stored in its original container. Per representative, the last fire inspection was conducted this year, but the date is unknown.

Facility representative was reminded to access the CCLD Licensing website at www.ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
	VISIT DATE: 05/21/2025

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe sleep; as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. State law prohibits baby walkers, bouncy seats, exersaucers, or any other items that fall into that category.

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.

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/.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
	VISIT DATE: 05/21/2025

NARRATIVE

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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 childcare 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). Or LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Facility representative was informed of the MyChildCarePlan.org website, a
consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at:
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
	VISIT DATE: 05/21/2025

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.

The CCLD On Duty Worker is available: Monday through Friday from 8:00 AM - 5:00 PM, at (661) 202-3318 for questions, information, and Unusual Incident Reporting. Once the incident is reported within twenty-four (24) hours, follow up with a written report via email to unusualincidentreport@dss.ca.gov or via fax (661) 202-3810.

There are deficiencies cited during this inspection. See LIC 809D pages attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, this report, and Appeal Rights were provided to Josephine (Shirley) Johnson, Facility Representative. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

NAME OF LICENSING PROGRAM MANAGER: Francisco Pedroza
NAME OF LICENSING PROGRAM ANALYST: Kuliema Calloway
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/23/2025 03:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/21/2025 04:41 PM

Created By: Kuliema Calloway On 05/21/2025 at 02:18 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MAGIC CAROUSEL MONTESSORI PRESCHOOL	FACILITY NUMBER: 197493008
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/21/2025

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
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in the staff S1, S2, S3, S5, and S6 did not have immunization for measles, TDAP and flu, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/06/2025
	Plan of Correction
1 2 3 4	Representative will provide proof by POC date.

Type B

Section Cited

CCR

101416.2(c)(1)(A)

Infant Care Teacher Qualifications and Duties

(c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants. 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 in teacher in the infant room did not have infant and toddler class in their file during the inspection which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/13/2025
	Plan of Correction
1 2 3 4	Representative will provide proof by POC date.

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:

	Kuliema Calloway
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC809 (FAS) - (06/04)

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