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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750154
Report Date: 06/21/2023
Date Signed: 06/21/2023 01:33:41 PM

Document Has Been Signed on 06/21/2023 01:33 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:HUBERT HUMPHREY CHILD CARE CENTERFACILITY NUMBER:
197750154
ADMINISTRATOR:LASHON TILLIE-JONESFACILITY TYPE:
850
ADDRESS:12560 FILMORE STREETTELEPHONE:
(212) 202-2700
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
06/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Carolyn James, Principal Recreation Supervisor, Daniel Gutierrez, Sr Rec Dir.; and Lashon Tille-Jones, Child Care Program ManagerTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Maddox met with Carolyn James, Principal Recreation Supervisor, Daniel Gutierrez, Sr Rec Dir.; and Lashon Tille-Jones, Child Care Program Manager today for the purpose of conducting an announced Prelicensing inspection. This facility is located within the Hubert Humphrey Recreation Center. There is a Swimming pool located in an adjacent building not connected to the center. This center consist of 1 classroom, kitchen, bathrooms, 2 offices, and outside play area. The hours of operation will be: Mon - Friday from 7:00 am to 6:00pm and will serve children ages
2 - 6 yrs. Off-limit areas include both offices, staff bathroom, kitchen, storage rooms, and any areas outside that has free public access.
INDOOR ACTIVITY SPACE:

· The child care center was toured and found to be clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors


· Floors of all rooms have a surface that is safe and clean (tiled flooring)
· A comfortable temperature for children shall always be maintained.
· Furniture and equipment are maintained in good condition, free of sharp, lose or pointed parts. There are a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.
· Tables and chairs were present to meet the needs of the children.
· Drinking water will be supplied with water pitchers and disposable cups or personal sippy cups.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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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: HUBERT HUMPHREY CHILD CARE CENTER
FACILITY NUMBER: 197750154
VISIT DATE: 06/21/2023
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·Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were stored and inaccessible to children (stored in the kitchen and storage room which will be kept locked while children are present).
· There are fully stocked first-aid kit(s) in locations accessible to staff but inaccessible to children:
· The isolation is located in a room behind the rear office for any child who becomes ill during the day.
· LPA observed operable carbon monoxide detectors and smoke detectors and Fire extinguishers are located throughout the facility and fully charged and operational.
· The center has a working telephone
· Sign-in and out procedure will be conducted manually
· Staff shall conduct a wellness check on children upon arrival to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.
OUTDOOR

The play yard (located in the rear of the building and completely surrounded by fenced more than 4ft high), the yard was free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. There is a sand box on the play yard, staff state they are contemplating revamping it to a garden. There was no high climbing apparatus' on the play yard. Staff will bring water pictures out with disposable cups until the water fountain is tested for Lead. Children have a safe path to and from the play yard.

RESTROOMS

There are 2 bathrooms designated for children, both bathrooms are located witin the classroom. All toilets and hand washing facilities shall be maintained in safe and sanitary operating condition. There is a separate staff bathroom located in the rear of the center next to the play yard.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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: HUBERT HUMPHREY CHILD CARE CENTER
FACILITY NUMBER: 197750154
VISIT DATE: 06/21/2023
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SUPERVISION:

Staff shall ensure no child is left without the supervision of a teacher at any time, Supervision shall include visual observation.

TRANSPORTATION:

Center will not provide transportation at this time.

CHILDREN’S RECORDS:

LPA explained all children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours.


HEALTH RELATED SERVICES:

Medications shall be kept in a safe place inaccessible to children.

A refrigerator shall be used to store any medication that requires refrigeration.

Licensee has implemented a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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: HUBERT HUMPHREY CHILD CARE CENTER
FACILITY NUMBER: 197750154
VISIT DATE: 06/21/2023
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FOOD SERVICES
  • Center will provide snacks only at this time until the secure a food vendor who will provide Breakfast, lunch, and snacks.

· Pesticides and other similar toxic substances were not stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored. Soaps, detergents, cleaning compounds or similar substances were stored in areas separate from food supplies.
· Food-preparation and storage areas shall be kept clean and free of litter and rubbish; and measures shall be taken to keep all such areas free of rodents and other vermin.
· Trashcans, including moveable bins, shall have a tight fitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof.
· There is a refrigerator available to store any medication that requires refrigeration.
POSTINGS:

Staff are aware of the forms that must be posted after licensure including the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5

Staff has a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. Staff are reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

The licensee was reminded it is his/her responsibility to visit the departments website to obtain licensing forms, Quarterly Updates, and Provider Information Notices (PINs): www.ccld.ca.gov

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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: HUBERT HUMPHREY CHILD CARE CENTER
FACILITY NUMBER: 197750154
VISIT DATE: 06/21/2023
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Measurements taken were as follows:
Inside: 43 X 43 = 1849-(cubbies 15 X 2.5 = 38) = 1811/52

Bathroom:
There are 2 separate bathrooms designated for children
Girls Bathroom has 3 stalls and 2 sinks = 30
Boys Bathroom has 2 urinals/2 stalls/2 sinks = 30
Total Bathroom: 60

Outside play space:
70 X 42 = 2,940/75 = 39
A waiver is needed to share the outside play yard with PS children. Licensee will need to submit an outside schedule that must remain posted along with the waiver.

The following was discussed with the licensee:
Smoking is prohibited on the premises of a child care center;Earthquake safety and necessity of drills are to be conducted every 6 months and logged; Required forms for children’s files, facility files, staff files, and posting requirements; Fingerprint clearances and the transfer process.

LPA reminded Staff of the requirement to have all water used for drinking, washing hands, and cooking shall be tested for Lead within 180 days after licensure.

Fire Clearance has been received for the requested capacity of 60 children, however, with measurements taken today, center can accommodate 52 PS children.

An exit Interview was conducted, a copy of this Report and a Notice of Site Visit was provided to Staff members present. Staff will need to place stair steps for small children to access the sinks, also, have toilet inserts in the adult size toilets.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
LIC809 (FAS) - (06/04)
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