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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801077
Report Date: 08/22/2023
Date Signed: 08/22/2023 04:32:58 PM


Document Has Been Signed on 08/22/2023 04:32 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801077
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
850
ADDRESS:329 S. MILL ST.TELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:64CENSUS: DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Madisann ParksTIME COMPLETED:
02:05 PM
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On 08/22/2023 Program Analyst (LPA) Beneroso met with the Director Madisann Park and conducted an Annual Random inspection. LPA toured and inspected the Preschool program with Toddler Component in accordance with the facility sketch. LPA observed 33 children with 4 Teachers providing care and supervision. The facility consists of 6 classrooms. The center also operates an Infant Program (#153801387). The hours of operation are 6:00 am - 6:00 PM Monday -Friday for the Preschool program and Toddler Component. Teacher child ratios were observed, and staff names recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. All staff has background clearance.

Indoor/Children's Area: Indoor activity space has appropriate furniture and equipment. The equipment was inspected for age appropriateness and good repair. The Preschool Program and the Toddler Component center is equipped with age-appropriate furniture and equipment including mats, tables and chairs. Per Director equipment, toys and furnishings are sanitized daily. LPA observed paint peeling off in one of the rooms by the window, which poses a potential risk for children in care. A Type B Violation was cited for this deficiency.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077
VISIT DATE: 08/22/2023
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Floors are clean and safe, cleaning compounds are inaccessible (locked in storage room) furniture and equipment in good condition. Each child has own cubby, trash cans have tight fitting lids. LPA observed the carbon monoxide, Fire Extinguisher and smoke detector in working condition. There is a working telephone on the premises, isolation area for ill children in the director’s office. Room temperature is comfortable, a fully stocked First Aid Kit was observed, sign in/out sheets were reviewed and contain legal signatures.

Napping: There are mats available for nap time. Each mat is used for one child at a time, bedding changed weekly or as needed, mats are arranged to allow staff to reach a child without having to step over a child. Bedding is stored as to not come in contact with other bedding.

Records: Children’s files have all the required forms; however, there were no sleep logs for the Toddler Program. A Type B Citation was issued for this deficiency. Staff records were reviewed and were found to be complete.

Bathrooms: LPA observed three bathrooms complete with supplies. LPA observed toilets to be unclean. A Type B Citation was issued for this deficiency. Cleaning products are kept in storage (locked), inaccessible to children.

Child Food Service: LPA observed appropriate chairs and tables for children in care and equipment in good repair. Per director, the facility currently has a food program. The kitchen was found to be fully stocked and equipped. Menus were available for review. Cleaning components were observed to be stored away from food items.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077
VISIT DATE: 08/22/2023
NARRATIVE
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LPA observed Licensing and Parent boards to be incompliance including the required posting (menu, daily schedule, community activities, licensing required documents). Fire/earthquake drills current, last fire/emergency disaster drill was conducted on 07/05/2023. Roster current and maintained. Staff present have current CPR/First Aid, it expires on 03/11/2025. Mandated Reporter is maintained current, it expires 03/13/2024.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled children devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077
VISIT DATE: 08/22/2023
NARRATIVE
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Outdoor: Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. The outdoor play area was observed to be free of debris. There is an area for shade and rest. Drinking water is available for children during outdoor and indoor playtime. Staff inspect outside play area prior to children exiting to the play area. Outside area is completely fenced. The outdoor space is maintained in a safe condition and is free of hazards, cushion material to absorb fall. LPA observed adequate outside shade, play ground free from hazards and debris.

Three type B deficiencies were cited during inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director, Madisann Parks.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6
Document Has Been Signed on 08/22/2023 04:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
Fixtures, Furniture, Equipment and Supplies
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA Observed paint coming off/ in classroom #6 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/05/2023
Plan of Correction
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Director will send proof of repairs to LPA Beneroso no later than 09/05/2023
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. LPA Observed toilets in all three bathrooms unclean which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will send proof of toilets being cleaned to LPA Beneroso no later than 08/25/2023
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6


Document Has Been Signed on 08/22/2023 04:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801077

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observationm interview and ecord review, the licensee did not comply with the section cited above. Facility does not keep sleep logs for their toddler program, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will send proof of sleep logs to LPA Beneroso no later than 08/25/2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6