143801727-6-1-2022-12-CC-SMOA-CEYN5K-20220601100941

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 143801727
Report Date: 06/01/2022
Date Signed: 06/01/2022 10:09:51 AM

Document Has Been Signed on 06/01/2022 10:09 AM - 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	ICSS-BIG PINE STATE PRESCHOOL		FACILITY NUMBER:	143801727
ADMINISTRATOR:	KAT DUNCAN		FACILITY TYPE:	850
ADDRESS:	500 S. MAIN STREET		TELEPHONE:	(760) 938-2222
CITY:	BIG PINE	STATE: CA	ZIP CODE:	93513
CAPACITY:	23	CENSUS: 7	DATE:	06/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Amber Fletcher Lead teacher		TIME COMPLETED:	10:15 AM

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	Licensing Program Analyst (LPA) Steven Montoya met with Lead Teacher (LT), Amber Fletcher for the purpose of an unannounced Annual/Random inspection of the preschool. Teacher/child ratios were observed. LPA observed 6 children and 1 teachers present during this inspection. Preschool consist of one classroom for one half day session. The facility operates from 8:00 am to 12:00 pm. During this inspection LPA toured the facility, observed equipment/supplies, and reviewed a sample of children and staff files. LPA observed staff and children files. Children are inspected for illnesses as they arrive. There is a separate area for isolation quite cube area. Furniture and equipment were inspected for age appropriateness and good repair. All rooms observed to be clean and safe. Telephone service was verified (760) 938-2222 Ext 2440. Heating, lighting, and ventilation are adequate. There are cubbies with children's names on them for their belongings in each classroom. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water bottles. Per LT, children do not nap on site, due to half day schedule. Facility has a surveillance system on the premises. Fire extinguisher, smoke detector and carbon monoxide detector were observed to be operable condition.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ICSS-BIG PINE STATE PRESCHOOL	FACILITY NUMBER: 143801727
	VISIT DATE: 06/01/2022

NARRATIVE

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Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. LPA observed small and large (anchored) play structures with sand underneath and a grass area for active play. There is also a concrete path for tricycles. The area was observed to be free of debris. There is an area for shade and rest. Drinking water is not available. There are no bodies of water on the premises.

LPA inspected and observed the 1 bathrooms to be clean, functioning properly and age appropriate. The Pre-K class bathroom has 1 toilet and 1 sink. LPA observed them all to be clean with soap, toilet paper and paper towels readily available in each. There is a clean kitchen with refrigerator, microwave, and sink. Knives are kept inaccessible over microwave.

The facility provides morning snack, which are stored in the kitchen beside the refrigerator. Weekly menus are posted in the kitchen. LT reports there are no current children with allergies. The chemicals are kept separate from the food, in child locked cabinet.

Fire/earthquake drills are current. Staff was reminded to review the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

A review of medication policy indicated that prescription medication is administered and only with parent's written permission. The teacher administers medication and documents the dosage, date and time onto a log.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ICSS-BIG PINE STATE PRESCHOOL	FACILITY NUMBER: 143801727
	VISIT DATE: 06/01/2022

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The following information was discussed with the Lead Teacher:
ü Mandatory Forms for the children’s files and provider’s files.
ü Requirements for fire drills, earthquake drills, and documentation for both.
ü The role and responsibilities of being a mandated reporter were discussed.
ü The lead teacher was reminded 100% supervision is required for children at all
times.

Lead Teacher was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624

Lead Teacher was advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.

Our Quarterly updates come out every 3 months they are also now in Spanish please log in to the CCLD website or you can email our advocates to have the quarterly updates send directly to your email. Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

No deficiencies cited.

Exit interview conducted, report was read and copy was provided to the Lead Teacher Amber Fletcher. Notice of Site Visit given to be posted for 30 days

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022

LIC809 (FAS) - (06/04)

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