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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844266
Report Date: 06/29/2023
Date Signed: 06/29/2023 03:43:29 PM

Document Has Been Signed on 06/29/2023 03:43 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:READY SET GROW LEARNING SERVICESFACILITY NUMBER:
364844266
ADMINISTRATOR:LILAMANIE SENEWIRATNEFACILITY TYPE:
850
ADDRESS:1528 PUMALO STREETTELEPHONE:
(909) 883-6628
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 51DATE:
06/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Office Administrator, Angie BustillosTIME COMPLETED:
03:58 PM
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Licensing Program Analyst (LPA) Maddox met with Office Administrator, Angie Bustillos today for the purpose of conducting a Case Management inspection regarding an unusual incident that occurred on 6/26/2023. Staff met the requirement to self report within 24 hrs and the UIR was submitted on 6/27/2023.
From information obtain, On 6/26/23 at approximately 4:15 , child #1 was outside playing around the concrete tunnels (pictures taken) on the play yard. There are 2 individual, stand alone tunnels, and 3 conjoined tunnels connected to form a larger tunnel. The larger concrete tunnel has 2 areas of separation. Child #1 decided to wedge her hand in one of the areas of separation and consequently, her hand got stuck as she tried to pull it out. Teacher, Ms Breanna tried to pull her hand out to no avail, other staff also tried by using soap and water but they were not able to free her hand. Staff decided to call 911 and the Paramedics arrived shortly. Staff state it took at least 4 Paramedics to free child #1's hand from the crack of the tunnel. After her hand was freed, staff noticed a little swelling and applied an ice pack. No medical treatment was required. Parent of child #1 was contacted.
LPA inspected the play yard and noted the conjoined concrete tunnels pose a health and safety risk to children due to the areas of separation on the larger tunnel and a rough jagged edge on another tunnel (it appears as though a piece of the tunnel was broken off, the broken area is about 5 - 7 inches long and approximately 2 - 3 inches wide). In addition, LPA noticed the sidewalk has 2 uneven areas that pose a tripping hazard for children. 3 Type B citations were issued today. Exit interview conducted, copy of this report was left with Office Administrator, Angie Bustillos.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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Document Has Been Signed on 06/29/2023 03:43 PM - It Cannot Be Edited


Created By: Donna Maddox On 06/29/2023 at 03:00 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: READY SET GROW LEARNING SERVICES
FACILITY NUMBER: 364844266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights- (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Staff will place a concrete sealant over the areas of separation on the conjoined areas of the concrete tunnel
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This requirement was not met as evidenced by: because the play equipment on the play yard is not in good condition, child #1 got her hand stuck in one of the areas of separation of a concrete tunnel and Paramedics had to be called to free her hand.
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Type B
06/30/2023
Section Cited
CCR101238.2

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Outdoor Activity Space - (d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned. This requirement was not met as evidenced by: there are
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Staff shall contact the case carrying LPA within 7 days with a plan to make this area a safe environement for children in care.
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areas of the concrete sidewalk that are uneven causing a tripping hazard to children 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:Lady King
LICENSING EVALUATOR NAME:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


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Document Has Been Signed on 06/29/2023 03:43 PM - It Cannot Be Edited


Created By: Donna Maddox On 06/29/2023 at 03:14 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: READY SET GROW LEARNING SERVICES
FACILITY NUMBER: 364844266

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/07/2023
Section Cited
CCR
101239(o)(1)

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Fixtures, Furniture, Equipment and Supplies - Equipment shall be maintained in a safe condition, free of sharp, loose or pointed parts.
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Within 7 days, the Director shall notify the case carrying LPA with a plan to repair the jagged edge of the concrete tunnel to provide a safe environment to children in care.
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This requirement was not met as evidenced by: the edge of one of the 3 concrete tunnels has a rough, jagged edge that poses a safety hazard for children 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:Lady King
LICENSING EVALUATOR NAME:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
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