130805126-5-23-2023-20-CC-LGAO-CS52AN-20230523171349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 130805126
Report Date: 05/23/2023
Date Signed: 05/23/2023 05:13:56 PM

Document Has Been Signed on 05/23/2023 05:13 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	ICOE-ECEP LITTLE VIKINGS II STATE PRESCHOOL		FACILITY NUMBER:	130805126
ADMINISTRATOR:	SARA PALACIOS		FACILITY TYPE:	850
ADDRESS:	627A EAST SIXTH STREET		TELEPHONE:	(760) 356-2030
CITY:	HOLTVILLE	STATE: CA	ZIP CODE:	92250
CAPACITY:	30	CENSUS: 22	DATE:	05/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Site Supervisor Sara Palacios		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/23/23 at 2:15PM, Licensing Program Analyst (LPA) Luigi Gargaro, conducted an unannounced annual inspection visit and met with facility site supervisor Sara Palacios. LPA disclosed the purpose of the visit and toured the facility indoors and outdoors. The preschool program consists of two half day sessions. The AM session runs from 8:00AM-11:00AM while the PM session runs from 12:30PM-3:30PM. The program operates under the conventional state school schedule with its co-located elementary school. Days of operation are Monday-Friday. The program operates out of the one preschool classroom at the facility. The following ratios were observed: there were 20 children present under the supervision of site supervisor Palacios, teachers Alma Cortez and Josefina Lizarraga and instructional aide Ana Ledesma There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. The facility does provide breakfast in the morning and lunch in the afternoon to children in care from the program's co-located elementary school cafeteria. Drinking water is available both indoors and outdoors. The outdoor play area is a fenced playground. Areas around any high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ICOE-ECEP LITTLE VIKINGS II STATE PRESCHOOL	FACILITY NUMBER: 130805126
	VISIT DATE: 05/23/2023

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A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption. Capacity and limitations as specified on the license are being maintained. At least one opening and closing staff member has current CPR/First Aid certifications.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. The analyst reviewed staff files which contained health screening with proof of required immunizations. Not all staff for whom records were reviewed had copies of current Mandated Reporter Training in their files but analyst found indication that staff typically takes training at the same time but not all certifications have been filed.

This facility provides Incidental Medical Services (IMS) but currently has no children in care who have any type of administered medication or need for IMS. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. The facility has a documented IMS plan in place. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA provided the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, California Megan’s Law (www.meganslaw.ca.gov), Lead Poisoning Facts, Forms and Regulations.

No violations were cited during today's visit. An exit interview was conducted with Site Supervisor Palacios and she was provided with a copy of today's report and the facility's appeal rights (LIC 9058). This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Jason Garay	TELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi Gargaro	TELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC809 (FAS) - (06/04)

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