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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750059
Report Date: 01/08/2024
Date Signed: 01/08/2024 03:42:24 PM

Document Has Been Signed on 01/08/2024 03:42 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:LITTLE MOUNTAIN PRESCHOOLFACILITY NUMBER:
367750059
ADMINISTRATOR:APRIL DOGEROFACILITY TYPE:
830
ADDRESS:2915 LITTLE MOUNTAIN DRIVETELEPHONE:
(909) 882-1100
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 11DATE:
01/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator April Dogero TIME COMPLETED:
02:30 PM
NARRATIVE
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On January 8, 2023, at 1:25 p.m., Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Jade Wilkinson. The purpose of the inspection was to conduct a health and safety check. LPA disclosed the purpose of the inspection to the facility representative. Present during today’s inspection were 11 infants with three staff members providing care and supervision.

At approximately 1:35p.m., LPA and facility representative conducted a tour of the infant classroom. LPA observed child 1 (C1) falling sleeping in staff 1 (S1) arms. LPA observed C1 was swaddled while in S1's arms. LPA conducted follow up staff interviews regarding the swaddling observation. Staff interviews confirmed C1 is routinely swaddled while sleeping at the Center.

Based on LPA observation and staff interviews, C1 has been swaddled while sleeping at the Center. Therefore a Type B citation for regulation 101430 (a)(3)(C) Infant Care Activities is being issued in accordance with the California Code of Regulations, Title 22, see LIC809D.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Administrator April Dogero.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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Document Has Been Signed on 01/08/2024 03:42 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 01/08/2024 at 02:53 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: LITTLE MOUNTAIN PRESCHOOL
FACILITY NUMBER: 367750059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2024
Section Cited
CCR
101430(a)(3)(C)

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101430 (a)(3)(C) Infant Care Activities:(a) Notwithstanding Section 101230,...(3) All infants shall be given the opportunity to sleep...(C) An infant shall not be swaddled while in care. This requirement was not met as evidenced by:
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Per Administrator, a staff training will take place regarding safe sleep regulations. A copy of the training and sign in sheet will be provided to the Department. Administrative staff will conduct checks to ensure staff are following safe sleep regulations.
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Based on LPA observation and staff interviews the Center did not ensure infants shall not be swaddled when C1 was observed being swaddled on 1/8/2024, which poses a potential health and safety risk 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:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


LIC809 (FAS) - (06/04)
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