Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492944
Report Date: 04/27/2018
Date Signed 04/27/2018 10:49:06 AM

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: 4DATE:
04/27/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Kimberly McKinneyTIME COMPLETED:
11:03 AM
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Licensing Program Analyst (LPA) Maddox met with Kimberly McKinney, Director today for the purpose of conducting a Case Management (CM) visit. This CM visit is conducted to discuss an Unusual Incident Report (UIR) received regarding child #1.

The first incident involved a child who proceeded to have a temper tantrum after his mom dropped him off at Kids Town. Child #1 began hitting the door with is hands, then began hitting the back of his head and body up against the door in Suite #127. Staff person #1 approached child #1 and took his hand in an effort try to calm him down. Staff #1 stated child #1 pulled away from her, fell on the floor and continued with a tantrum (crying and flailing his arms). She stated she went to the office and asked Asst. Director if it was okay to pick him up, she said okay. She stated she picked him up and noticed his head was bleeding, she immediately took him to the office, child #1 was still flailing his arms and crying. Asst. Director cleaned the area, contacted Mom (left vm), and the Director. Mom called back (about 10 min later) and spoke with Staff #1 to see if child #1 was okay. Staff person #1 informed mom that he was okay but he sustained a small cut (about 3/4 of an inch) on the back of his head. Asst. Director took pictures of the injury (picture viewed during this visit). Child #1 has 2 siblings, all still in attendance.
SUPERVISOR'S NAME: Burnett MageeTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2018
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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