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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750148
Report Date: 01/31/2024
Date Signed: 01/31/2024 06:40:08 PM


Document Has Been Signed on 01/31/2024 06:40 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:CCRC 10TH STREET HEAD STARTFACILITY NUMBER:
197750148
ADMINISTRATOR:BEATRIZ ZAMORANO-PEDREGONFACILITY TYPE:
830
ADDRESS:44236 10TH STREET WESTTELEPHONE:
(661) 494-7999
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:54CENSUS: 2DATE:
01/31/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Supervisor Noemi TovarTIME COMPLETED:
06:45 PM
NARRATIVE
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On 1/31/2024 at 12:26pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by Supervisor Noemi Tovar who permitted entry to the facility. LPA toured the facility with the Supervisor according to the facility sketch. Upon arrival, LPA observed 2 children with 1 staff member providing care and supervision.

During this inspection, LPA received pertinent documents related to this investigation which included the facility’s staff and children’s rosters, personnel records, and other relevant documents. At 12:56pm, LPA Pittman and the Supervisor entered the infant classroom. LPA Pittman observed in the infant classroom that C1 and C2 were sleeping on cots to the left of the infant sleeping area, in the activity area. LPA Pittman interviewed S1 to inquire why the infants were sleeping on cots instead of the cribs. S1 admitted that the children were unable to climb out of the cribs. Furthermore, S1 admitted that they were informed to place the infants on cots after they turn 12 months. LPA Pittman informed the Supervisor and S1 of the policy regarding infants and sleeping equipment. S1 immediately removed C1 and C2 from the cots on the floor in the activity area and placed them in the cribs in the sleeping area. This is a Type B violation, see the LIC 809D for the details. At 12:58pm, LPA Pittman observed in the infant classroom that the infant sleep chart for C1 and C2 was last updated at 12:35pm for C1 and 12:40pm for C2. S1 admitted during interview that they had not updated the chart yet. This is a Type B Violation, see the LIC 809D for the details.

As a result of the inspection, the facility was found to be in noncompliance with Title 22 Regulations and has been cited two Type B deficiencies, see the LIC 809D for the details.

All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, and a copy of this report was read and provided to the Supervisor along with the Notice of Site Visit and Appeal Rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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 01/31/2024 06:40 PM - It Cannot Be Edited

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: CCRC 10TH STREET HEAD START
FACILITY NUMBER: 197750148

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2024
Section Cited
CCR
101429(a)(B)

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101429 Responsibility for Providing Care and Supervision for Infants (a) In addition to Section 101229… (B) Staff shall physically check on sleeping infant(s) every 15 minutes and document…

This requirement is not met as evidenced by:
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Supervisor will send via e-mail proof of training staff on checking infants every 15 minutes no later than 2/14/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above as S1 did not document the infant sleeping log every 15 minutes of the sleeping infants (C1 and C2) which poses a potential health, safety or personal rights risk to persons in care.
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Type B
02/14/2024
Section Cited
CCR101439.1(b)

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101439.1 Infant Care Center Sleeping Equipment (b) A crib or portable-crib… shall be provided for each infant who is unable to climb out of a crib

This requirement is not met as evidenced by:
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Supervisor will send via e-mail proof of training staff on checking infants every 15 minutes no later than 2/14/2024.
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Based on observations, interviews, and record reviews, the Licensee did not comply with the section cited above as S1 admitted that C1 and C2 were unable to climb out of cribs but did not have them sleeping in a crib which poses a potential 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 RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2