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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750015
Report Date: 07/17/2023
Date Signed: 07/17/2023 11:29:33 AM

Document Has Been Signed on 07/17/2023 11:29 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:LANCASTER MONTESSORI PRESCHOOLFACILITY NUMBER:
197750015
ADMINISTRATOR:LALANIE HERATHFACILITY TYPE:
850
ADDRESS:933 NEWGROVE AVETELEPHONE:
(661) 723-0026
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 9DATE:
07/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Director Karen JonesTIME COMPLETED:
11:35 AM
NARRATIVE
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On 7/17/2023 at 9:43am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management inspection. The LPA disclosed the purpose of the inspection and was permitted entry by the Director Karen Jones. The Director guided the LPA on a tour of the home. Upon entry to the facility, the LPA observe 9 children in care and two staff providing care and supervision (fingerprint cleared and associated to the center.)

LPA informed the Director of the purpose of the visit. The documents required to change the Director to Karen Jones is incomplete and missing and the certified mail that was previously sent on 5/22/2023 returned as undeliverable on 6/22/2023. There is a front gate that requires a code and the mail carriers do not have the code to the front gate but there is a bell that can be rung and heard inside the center if someone needs to enter the facility. The Director stated that the mail carriers do not always ring the bell to notify the staff that there is a package that needs to be signed off to be received.

The Director was able to provide the following missing documents: Mandated Reporter Certificate dated 3/17/2023, the Health and Safety Certificate, and the Transcripts.

The Director needs to provide the following missing documents within two weeks on 7/31/2023: proof of completion of an EMSA Certified Pediatric First Aid & CPR Training Certificate, MMR and Tdap vaccines, character reference letter, and the Board of Resolution authorizing the appointment of Karen Jones as the new director from the Board. This is a Type B violation, see the LIC 809D for the details.

A Type B violation has been cited for the missing documents for the Director, see the LIC 809D. An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with the Director.

All licensing reports are recommended to be kept for 3 years and the Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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Document Has Been Signed on 07/17/2023 11:29 AM - It Cannot Be Edited


Created By: Andrea Pittman On 07/17/2023 at 11:01 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: LANCASTER MONTESSORI PRESCHOOL
FACILITY NUMBER: 197750015

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2023
Section Cited
HSC
1596.866

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1596.866 Additional health and safety training... (a) (1) In addition to other required training, at least one director or teacher at each day care center...shall have training...(2) The training shall include the following components:
(A) Pediatric first aid.
(B) Pediatric cardiopulmonary resuscitation (CPR).

This requirement was not met as evidenced by:
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Director will provide a copy of the Pediatric First Aid & CPR from an EMSA Certified Provider and other missing documents via e-mail no later than 7/31/2023
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Based on observation, interview, and record review, the Licensee did not meet this requirement when the EMSA Certified Pediatric First Aid & CPR was not present in the Director's file which poses a potential risk to the Health, Safety, or Personal Rights risk to persons in care.
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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:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023


LIC809 (FAS) - (06/04)
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