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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750163
Report Date: 05/25/2023
Date Signed: 05/25/2023 01:12:03 PM

Document Has Been Signed on 05/25/2023 01:12 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:ACADEMY OF EXCELLENCEFACILITY NUMBER:
197750163
ADMINISTRATOR:BEVERLY MOODYFACILITY TYPE:
840
ADDRESS:1324 WEST AVENUE J SUITE 5TELEPHONE:
(661) 206-9344
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
05/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Applicant Chauncey SmithTIME COMPLETED:
10:39 AM
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Licensing Program Analyst (LPA) Maddox met with Applicant Chauncey Smith today for the purpose of conducting a pre-Licensing inspection. Applicant is requesting a capacity of 30 School-age (SA) children ages 6 - 12 yrs. Applicant has also submitted applications for an Infant (X197750162) and PS Component (X 197750161). This will be Applicants second location, the first location is located at 725 E AVENUE J, Lancaster, CA 93535. During this inspection, LPA measured 1 classroom, 2 bathrooms, and the outside play area designated for SA children. The hours of operation will be: Mon through Saturday from 6:30 am 11:00 pm. This center is located in the rear of a strip mall

INDOOR ACTIVITY SPACE:
  • A comfortable temperature for children shall always be maintained.
  • Tables and chairs were present to meet the needs of the children.
  • Center will use Culligan Water Company for drinking water
  • Disinfectants, cleaning solutions, poisons and other items that could pose a danger if accessible will be stored in the storage room located between the Infant kitchen and Staff bathroom.
  • The isolation is located in an separate room located in the PS classroom office for any child who becomes ill during the day.
  • LPA observed operable carbon monoxide detectors and smoke detectors(hard wired). Fire extinguishers are located throughout the facility and fully charged.
  • The center has a working telephone
  • Sign-in and out procedure will be done manually.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750163
VISIT DATE: 05/25/2023
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  • Licensee is advised to conduct a wellness check to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.
  • Indoor activity space provided for school-age child care center children shall be physically separated from space provided for infant care and child care center children.
OUTDOOR

The entire outdoor space is surrounded by chain link fencing. LPA observed a shaded rest area for children, children have access the outdoor play yard in a safe manner. There are no bodies of water on the premises. As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls (center will utilize rubber matting).

RESTROOMS

There are 2 bathrooms designated for SA children, one bathroom has 1 toilet and 1 sink, the 2nd bathroom has 1 urinal and 1 sink. All toilets and hand washing facilities shall be maintained in safe and sanitary operating condition.

There are 2 Staff bathrooms located within the center, staff bathrooms are also designated as isolation bathrooms.

SUPERVISION:

Applicant shall ensure no child is left without the supervision of a teacher at any time and adhere to the teacher/child ratios (SA 1:14)

TRANSPORTATION:

Center will provide transportation for SA children.

CHILDREN’S RECORDS:


Applicant is aware of the forms required for children's records which shall be available to the Department to inspect, audit, and copy upon demand during normal business hours.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750163
VISIT DATE: 05/25/2023
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NAPPING

SA children will not be required to nap, however, SA children will have the opportunity to have a quiet resting area if needed.



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.

Applicant/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

FOOD SERVICES

Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

· Pesticides and other similar toxic substances will be stored in a storage room located between the Infant Kitchen and Staff lounge separate from food supplies.

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

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750163
VISIT DATE: 05/25/2023
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 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 and freezer available to store any medication that requires refrigeration.
· All foods shall be selected, transported, stored, and dated. Food in damaged containers shall not be accepted, used or retained.
POSTINGS:

Applicant is aware of the required forms that shall 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

Center has a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

Applicant is 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.



Measurements taken were as follows:
INDOOR
46 X 19 = 874/35 = 25
12 X 12 = 144/35 = 5
TOTAL CAPACITY = 30

BATHROOM:


2 bathrooms, 1 toilet and 1 sink and the 2nd bathroom 1 urinal and 1 sink.
TOTAL CAPACITY = 30
Outside play space:
56 X 53 = 2,968/75 = 40

The outside play schedule that shall remain posted during the hours of operation

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

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: ACADEMY OF EXCELLENCE
FACILITY NUMBER: 197750163
VISIT DATE: 05/25/2023
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Fire Clearance has been received for the requested capacity of 30 children.

Needed Prior to Licensure:

During this inspection, the center was not fully set up to receive children. The game room, bathrooms, outdoor and indoor space need 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.
  • Applicant will purchase first aid kits.
  • Applicant will send in pictures upon completion and before children are accepted.

Exit interview conducted, copy of report left at facility.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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