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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843306
Report Date: 09/10/2024
Date Signed: 09/10/2024 11:09:55 AM

Document Has Been Signed on 09/10/2024 11:09 AM - 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:BONANZA SCHOOL, LLCFACILITY NUMBER:
364843306
ADMINISTRATOR/
DIRECTOR:		ALICIA FLORESFACILITY TYPE:
830
ADDRESS:14624 BONANZA ROADTELEPHONE:
(760) 241-7800
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:39 AM
MET WITH:Michella EvansTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On September 10, 2024, Licensing Program Analyst (LPA) Calloway conducted a Case Management inspection at the above facility. LPA met with Facility Representative who granted access. LPA toured the facility with the representative and observed eighteen preschool daycare children in care, and four infants in care with four representatives.

LPA was in the facility to deliver complaint findings for 364841215 license and did a walk through with the representative. During the walk through, LPA observed a seven-month infant asleep on their side. LPA reviewed the infants file and LIC 9227 for the infant and found, section C of the form was not completed, nor signed by a representative and the infant started care April 16, 2024. Therefore, the infant area was not in compliance with the Safe Sleep Regulations. Per Representative, they were not here on that day and it was overlooked.

Per Title 22 Regulations, there is a Type A deficiency cited. See 809 D page, attached to this report.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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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: BONANZA SCHOOL, LLC
FACILITY NUMBER: 364843306
VISIT DATE: 09/10/2024
NARRATIVE
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This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and licensee will obtain a signed acknowledgment of Licensing Reports (LIC- 9224) from parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit and Appeal Rights were provided to Michella Evans, Facility Representative. A Notice of Site Visit must be posted for thirty (30) consecutive days, failure to comply with posting will result in $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2024 11:09 AM - It Cannot Be Edited


Created By: Kuliema Calloway On 09/10/2024 at 10:53 AM
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: BONANZA SCHOOL, LLC
FACILITY NUMBER: 364843306

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2024
Section Cited
CCR
101419.2(a)(2)

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01419.2 Infant Needs and Services Plan (a) Prior to the infant's first day at the center, the... center director or assistant shall complete a needs and services plan for the infant.(2)The authorized representative shall sign the plan....This requirement is not met as evidenced by:
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Per Representative they will have the LIC 9227 form signed by the infant's representative at pick up today and will send to Licensing by POC date of 9/11/24.
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Based on observation, interview, and record review there was a seven month infant observed on their side without a signed LIC 9227 form, Section C by their representative to indicate if the infant could roll from back to side which poses an immediate health, safety, or personal rights risk to the person 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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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