Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012439
Report Date: 06/26/2018
Date Signed 06/26/2018 02:40:30 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:KIDZHAVENFACILITY NUMBER:
198012439
ADMINISTRATOR:CHAMPA S. PERERAFACILITY TYPE:
850
ADDRESS:9052 & 9052 1/2 SUNLAND BLVD.TELEPHONE:
(818) 767-2623
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:33CENSUS: 15DATE:
06/26/2018
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Champa PereraTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Joanne Alcala conducted an unannounced annual random site inspection. LPA met with Center Director, Champa Perera. LPA inspected the inside and outside of the facility.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed individual cubbies with children’s names. The facility uses the director office to isolate children when they are sick. Children are provided with cots for napping. Age appropriate sinks and toilets were inspected for availability and good repair. Toilet paper, paper towels were observed inside the restroom. First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers were observed. Trash cans with tight lids were observed.

The facility provides breakfast, lunch and snack to all day care chidren. LPA observed a water pitcher with cups inside the classrooms.

Fire and disaster drills are conducted monthly.

The facility roster was up to date and all staff have been fingerprinted and associated to the designated license number. Director and teachers are currently certified in pediatric first aid and CPR which expires on 05/19.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: KIDZHAVEN
FACILITY NUMBER: 198012439
VISIT DATE: 06/26/2018
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There were no bodies of water observed in the playground area. The outdoor playground was inspected and was observed to be free of hazards, loose and sharp parts. LPA did observed a large canopy that provides shade. Director stated that they take water bottles outdoors for the children to drink. The playground was observed to be properly gated all around. Equipment was inspected for safety, cushioning material, good repair and age appropriateness.

The following forms were observed to be posted. The facility license, Parent's Rights Poster (PUB 393), Personal Rights (LIC 613A), Emergency Disaster Plan (LIC 610), Child Car Seat Law (PUB 269).

All staff members have completed the mandated reporter training and have the required immunization's.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KIDZHAVEN
FACILITY NUMBER: 198012439
VISIT DATE: 06/26/2018
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For additional information and forms visit our website at: www.ccld.ca.gov
A copy of this report must be made available to the public for 3 years.
Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

Per the Title 22 regulations, on 06/26 /18, the above facility was found to be operating in substantial compliance. An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Joanne AlcalaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2018
LIC809 (FAS) - (06/04)
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