197750054-6-13-2024-12-CC-APIN-D67RGY-20240613130132

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750054
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:01:42 PM

Document Has Been Signed on 06/13/2024 01:01 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:	EVO TAEKWONDO ACADEMY		FACILITY NUMBER:	197750054
ADMINISTRATOR/ DIRECTOR:	THORNTON, KYLE		FACILITY TYPE:	840
ADDRESS:	43437 GADSDEN AVENUE, STE #A		TELEPHONE:	(661) 609-1568
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 90	CENSUS: 13	DATE:	06/13/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:48 AM
MET WITH:	Licensee Kyle Thornton		TIME VISIT/ INSPECTION COMPLETED:	01:20 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	On 6/13/2024 at 8:48am, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Inspection. LPA was met by Facility Representative and permitted to enter the facility. The Licensee Kyle Thornton guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 13 children and 3 staff providing care and supervision. Facility operates Monday through Friday from 7:30am to 6:00pm. Facility consists of a total of 13 rooms/areas: five classrooms, two indoor play areas, one office, one kitchen, one staff restroom, two children’s restroom, and one outdoor play area. Indoor Activity Space: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by the staff per requirements. LPA observed individual storage for children's belongings, including 131 individual cubbies. Children are provided filtered water from a large container dispensed in individual water bottles. An isolation area was inspected and located near a separate staff restroom in the office. The calming area was inspected and located in the office. Children are provided napping upon request, there are four cots available. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff. The Licensee was made aware that the facility fees are due and failure to pay the facility fees can result in the revocation of the license.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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 06/13/2024 01:01 PM - It Cannot Be Edited

Created By: Andrea Pittman On 06/13/2024 at 12:40 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: EVO TAEKWONDO ACADEMY	FACILITY NUMBER: 197750054
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. 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 by the Mandated Reporter Certification expiring for Staff 1 and 5 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2024
	Plan of Correction
1 2 3 4	Licensee will e-mail the proof of certifications for the Mandated Reporter Trainings for Staff 1 and 5 no later than 6/27/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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: EVO TAEKWONDO ACADEMY	FACILITY NUMBER: 197750054
	VISIT DATE: 06/13/2024

NARRATIVE

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Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition and are operating according to Fire Marshall standards as observed at 9:46am. LPA observed the first aid kit and it was found to be complete with the following supplies including tweezers, scissors, gauze, adhesive tape, bandages, cleansing pad/solution, thermometer, and a first aid manual and kept inaccessible to children in care in the off-limits kitchen area. Trash cans with tight lids were observed making solid wastes inaccessible to children in care; there were trash cans by the kitchen without lids that had solid waste, LPA provided technical assistance. Cleaning supplies, hazardous materials, and/or poisons are found to be out of the reach of children and in the off-limits kitchen under the sink in the cabinet; the Licensee was provided technical assistance in ensuring the door lock to the kitchen area is always engaged during operational hours. The facility does provide transportation: Licensee attests that the vehicles are insured, the vehicle registration is kept current, driver’s are licensed for the vehicles, and the driver’s are certified in CPR/First Aid. Per the Licensee, there is no smoking on the premises. Per the Licensee, there are no weapons, firearms, or ammunition on site; LPA did not observe any of the above.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 4/29/2024 at 1:00pm. The fire extinguisher (4A60BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 2023). Menus are posted at least a week in advanced, dated, and in sight of parents to review. Daily activity schedules are posted showing meal/snack times, and specific activities. The parent board was reviewed and has all the required forms posted accessible to parents, LPA provided the LIC 613A for posting and the Licensee immediately posted the document. Food allergies are posted in a plastic sleeve in both the food preparation and service areas. There is no outside food allowed and food brought from home by the children are properly labeled and refrigerated. The center provides meals: breakfast, lunch, and snacks.

Outdoor Activity Space:
The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. LPA observed climbing structures and other play equipment were found to be securely anchored with adequate, resilient, cushioning material underneath and around the perimeter. Children are provided filtered water via a large container dispensed in individual drinking bottles during outdoor play. There is adequate shaded area

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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: EVO TAEKWONDO ACADEMY	FACILITY NUMBER: 197750054
	VISIT DATE: 06/13/2024

NARRATIVE

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for rest. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area.

Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met.

Records/Documentation:
Children's records were reviewed for completeness. LIC 702- Preadmission Health History, LIC 700- Identification & Emergency contact, LIC 627- Consent for Medical Treatment, LIC 613A- Personal rights, LIC 995- Parent’s Rights, and LIC 701- Physician Reports or similar documents used by the facility; and Immunization Records are all in the children's file.

The facility roster was up to date and all staff have been fingerprinted and association to the designated license number. Personnel records were reviewed for completeness. Personnel records included immunizations, LIC 9052- Employee Rights, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse. Director and teachers are currently certified in Pediatric CPR/First Aid, expiring in 2025. Child Care Providers (AB1207) Mandated Reporter training certificate is valid for staff; however, Staff 1 and Staff 5 have expired trainings, this is a Type B violation, see the LIC 809D for the details. The facility maintains insurance on the facility.

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/.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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: EVO TAEKWONDO ACADEMY	FACILITY NUMBER: 197750054
	VISIT DATE: 06/13/2024

NARRATIVE

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

All staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 years. Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Staff is aware that all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot-line at (800) 540-4000.

For additional information and forms visit our website at: www.cdss.ca.gov

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

For updates on Community Care Licensing, please visit the following website at: Childcareadvocatesprogram@dss.ca.gov or call at (916) 654-1541.

A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations, this facility is not in compliance, a Type B Deficiency has been cited. Please, see the LIC 809D for the citation.

Exit interview conducted and report was reviewed with the Licensee Kyle Thornton and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC809 (FAS) - (06/04)

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