Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492944
Report Date: 11/02/2017
Date Signed 11/02/2017 12:00:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:KIDS TOWN CHILDCARE CENTER, LLCFACILITY NUMBER:
197492944
ADMINISTRATOR:KIMBERLY MCKINNEYFACILITY TYPE:
850
ADDRESS:1825 WEST AVENUE J, SUITE 123TELEPHONE:
(661) 951-2070
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:36CENSUS: 10DATE:
11/02/2017
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
12:17 PM
NARRATIVE
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Licensing Program Analyst (LPA) Maddox met with Director, Kim McKinney and Owner, Edsel Wayne Hooks today. While conducting a separate inspection, LPA noted the flooring in the pre-School area
(Suite #129) needs to more epoxy. LPA noted several areas where the epoxy is worn and you can see the cement.

This is a type B citation, not posing an imminent danger to children.
SUPERVISOR'S NAME: Burnett MageeTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2017
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: KIDS TOWN CHILDCARE CENTER, LLC
FACILITY NUMBER: 197492944
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2017
Section Cited
CCR
101238
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101238.3(b) Indoor Activity Space. All floors shall be safe and clean.
The epoxy needs replacing on the flooring, bare spots with cement showing.
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Center states they will have the flooring re-done by POC due date.
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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: Burnett MageeTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2017
LIC809 (FAS) - (06/04)
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