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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750154
Report Date: 06/27/2024
Date Signed: 06/27/2024 04:01:21 PM

Document Has Been Signed on 06/27/2024 04:01 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:HUBERT HUMPHREY CHILD CARE CENTERFACILITY NUMBER:
197750154
ADMINISTRATOR/
DIRECTOR:		LASHON TILLIE-JONESFACILITY TYPE:
850
ADDRESS:12560 FILMORE STREETTELEPHONE:
(212) 202-2700
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 2DATE:
06/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Melinda Sims, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 6/25/2024 Licensing Program Analyst (LPA), Isabel Ortega met with the Child Care Director, Melinda Sims and conducted an Annual Random Inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 2 children in care and 2 Staff providing care and supervision. Facility operates in two classrooms at Hubert Recreation Center. There is a swimming pool located in an adjacent building not connected to the Child Care Center. Facility is completely enclosed and separated from the Recreational Center.
An isolation area was inspected, which takes place in a room labeled isolation room cots and toys are available. Children have the option for rest time and quiet time if needed cots are provided. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms are cleaned, restocked of toiletries by staff on-site custodian. Staff disinfects, and sanitize daily through out the day.
The furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and AC ventilation were evaluated. LPA observed individual storage for children's belongings. There are two storage rooms maintained key locked utilized for equipment, storage, emergency supplies and art supplies.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 06/27/2024 04:01 PM - It Cannot Be Edited


Created By: Isabel Ortega On 06/27/2024 at 01:34 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: HUBERT HUMPHREY CHILD CARE CENTER
FACILITY NUMBER: 197750154

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024

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
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Based on observation, interview, and record review, 4 out of 4 Staff including the Director did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/23/2024
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lady King
LICENSING EVALUATOR NAME:Isabel Ortega
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024


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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: 06/27/2024
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The classroom consists of filtered water in a water jug container for indoor and an orange Igloo container is utilized for outdoor play. Children bring their own water bottles from home as desired or individual disposable cups available when needed. Water was tested for lead on 07/29/2023 and results were provided on 08/09/2023. Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, written directives, PIN 21-21 the areas sampled of lead did not exceed the Action Level Exceedance (ALE) of over 5.5 parts per billion (ppb).

Facility operates Monday through Friday from 9:00 a.m. to 12:00 p.m. Facility provides morning and afternoon snacks for children enrolled.

Facility has all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, carbon monoxide(tested at 11:45 a.m.) were observed to be operating properly. The fire extinguisher (2A10BC) is reading in green and meets the Fire Marshal codes and standards. LPA observed a white tag dated 9/01/2023 on the Fire Extinguisher service yearly.

Trash cans with tight lids were observed. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. A refrigerator is adequately equipped, clean, and free from hazards. There is hot running water in the kitchen area.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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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: 06/27/2024
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Cleaning supplies are out of reach of children. The cleaning supplies are kept locked under the kitchen sink.

Emergency Drills are conducted monthly last Fire drill was conducted and documented on 5/28/2024 at 10:15 a.m. and last earthquake drill was conducted on 5/14/2024 at 10:15 a.m. When food allergies are noted they are posted in the food preparation area and in each classroom. Currently there are no children with food allergies enrolled.

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. During outdoor play children are provided with filtered water in a water igloo container (disposable cups are available). There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.



The parent board was reviewed and has all the required forms. The snack menu is posted in the main entrance and parents receive a tangible copy in their in-box monthly. Facility has resources for parents at the entrance by the parent lobby.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; 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.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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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: 06/27/2024
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Staff are currently certified in Pediatric First Aid and CPR which does not expire until 08/19/2024. Facility was not able to provide Child Care Provider Mandated Reporter (AB1207) training certificates for staff, a Type B citation will be issued today.

The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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-carecenters/.
All staff are required to take the Child Care Provider Mandated Reporter (AB1207) training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations. 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. 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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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: 06/27/2024
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According to facility all staff are aware they 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

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

Per Title 22 Regulations facility is not complying with rules and regulation, facility is not in compliance, and one deficiency will be issued today Type B citation. An exit Interview was conducted with Director. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

A copy of this report must be made available to the public for 3 years. The Notice of site visit shall be visibly posted for 30 days.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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