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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493008
Report Date: 08/01/2024
Date Signed: 08/01/2024 11:16:17 AM

Document Has Been Signed on 08/01/2024 11:16 AM - 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 PRESCHOOLFACILITY NUMBER:
197493008
ADMINISTRATOR/
DIRECTOR:		SHIRLEY JOHNSONFACILITY TYPE:
830
ADDRESS:17956 SIERRA HIGHWAYTELEPHONE:
(661) 298-4065
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 36DATE:
08/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Director Shirley Johnson TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On August 01, 2024, Licensing Program Analyst (LPA) Andrew Alemoh conducted a case management inspection to conclude the Unusual Incident reported to the department by telephone and email on 07/10/2024; this incident was reported timely. LPA spoke with the Director regarding the incident. LPA toured the facility and took a census of the children. Upon arrival, there were 36 children and 8 staff present today at the facility along with the Director.

Description of the incident: An incident on 07/10/2024, Director called to notify the department that a S1 was covering the infants heads with blankets while pushing their heads down during nap time.



Based on the information obtained, it was determined that Staff #1 has been placing blankets to cover the infants head during nap time, along with pushing the infant’s heads down for sleep during nap time. The facility handled the situation accordingly by disassociating(terminating) Staff #1 from the facility.

This is a Type A violation which shall be posted for 30 consecutive days as there is immediate risk to the health and safety of the children in care. and an immediate health and safety regulations.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 08/01/2024
NARRATIVE
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Also, LPA Alemoh informed the Director Shirley to provide a copy of this licensing report dated that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted, and a copy of this report was provided to the licensee along with appeal rights and the Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/01/2024 11:16 AM - It Cannot Be Edited


Created By: Andrew Alemoh On 08/01/2024 at 10:59 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: MAGIC CAROUSEL MONTESSORI PRESCHOOL
FACILITY NUMBER: 197493008

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2024
Section Cited
CCR
101430(D)

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An infant's head shall not be covered while sleeping. Based on the interview and record review this requirement was not met as Staff #1 failed to ensure a safe, healthful, and comfortable accommodation which resulted in infant children’s head being covered by a blanket. This poses immediate health, safety, or personal rights risk to children in care.
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Training will be in placed. Training in the infant room with communication with the teachers: such as diaper changing logs, sleep logs, feeding time of the babies. Checking infant cribs. No blankets for the infants. Constant communication with teachers.

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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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrew Alemoh
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024


LIC809 (FAS) - (06/04)
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