153801889-5-1-2023-12-CC-EROZ-CREVM4-20230501163256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153801889
Report Date: 05/01/2023
Date Signed: 05/01/2023 04:33:29 PM

Document Has Been Signed on 05/01/2023 04:33 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	WIND IN THE WILLOWS PRESCHOOL, THE		FACILITY NUMBER:	153801889
ADMINISTRATOR:	MARTIN, SALINA		FACILITY TYPE:	850
ADDRESS:	12200 DEL ORO STREET		TELEPHONE:	(760) 762-1700
CITY:	BORON	STATE: CA	ZIP CODE:	93516
CAPACITY:	30	CENSUS: 13	DATE:	05/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Ashley Kostopoulos, Director		TIME COMPLETED:	12:45 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 05/01/23 at 08:40 a.m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced follow up inspection to an inspection that was initiated on 04/28/23. During today's inspection at the above Facility the LPA met with Center's Director, Ashley Kostopoulos and informed her that the LPA will continue to assess the Center's operation of their Preschool Program as indicated in previous report. The LPA provided copy of the Entrance Checklist form, LIC 125. The Site Supervisor provided copy of the Child Care Center children roster and Personnel Report (LIC 500). The Center maintains on file a current Designation of Facility Responsibility (LIC 308), Sign in and Sign Out Rosters, the Center has a current Parent Handbook. At 09:15 a.m. LPA Rodriguez along with Director, Ashley Kostopoulos conducted a walk trough of the inside and outside of the Facility along with the entire operation of the Facility/Center program. The LPA advise the Director to ensure the Facility has a definitive Plan of Operation (PO) in accordance with Title 22 Regulatory Requirements. The LPA provided copy of Title 22, Section Section 101173. The Facility shall operate in accordance with their PO. The Facility license is posted on a prominent place of the Center. During the walk through/inspection of the Facility the LPA discussed observations of Title 22 requirements. The Center is clean, safe, sanitary and well maintain. All utilities are operational and in good order. There is plenty parking space. First aid kits are available and complete (inaccessible to children/infants.) The fire extinguishers, smoke alarms and carbon monoxide monitors are in compliance and fully operational. The Center conducts and records emergency disaster drills. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible to children. Furniture and equipment were inspected for age appropriate and observed to be in good repair and defects free.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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

FACILITY NAME: WIND IN THE WILLOWS PRESCHOOL, THE	FACILITY NUMBER: 153801889
	VISIT DATE: 05/01/2023

NARRATIVE

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Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are inaccessible to children. Furniture and equipment were inspected for age appropriate and observed to be in good repair and defects free. Sign in/out rosters, telephone service, heating, lighting and ventilation were evaluated and no defects were noted. There are clean safe and sanitary individual space/cubbies with children's names. The facility utilizes a designated isolated area to isolate ill children. The toys and material use for instructions meet regulatory requirements. The trash cans contain tight lids. All toilets, hand washing, and bathing facilities shall be in safe and sanitary operating condition..

The outdoor play areas were noted free of hazards. Playground items are properly secure and free of loose or sharp objects. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures are age appropriate, play equipment is properly securely and anchored with adequate resilient. There is cushioning material underneath and around the inside and outside play areas. On the outside play area, there is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed.

LPA observed staff providing care and supervision children. At no time the LPA observed no child being unsupervised. The LPA conducted a review of several Staff records. The review included, but was not limited to the following: Criminal record statements (LIC 508) Record of submission of Child Abuse Index Checks. Staff qualification. Reference letters and verifying work experience on file. Health clearances, including TB clearances. Pediatric CPR/first aid cards for designated staff. 15 hours of health & safety training for designated Staff. Notice of Employee Rights receipts (LIC 9052). Statement Acknowledging Requirement to Report Suspected Child Abuse. (LIC 9108) and Mandated Reporter Training certificate. Copy of driver’s license. Personnel Record (LIC 501) or application/resume with required information.

A review of staff records on today's date indicates that the Center staff, and other individuals listed on the LIC 500, Personnel Report and other personnel working at the Facility have received Criminal Record, FBI, DOJ and Child Abuse Central Index Check clearances or exemptions. Staff. Notice of Employee Rights receipts (LIC 9052). Statement Acknowledging Requirement to Report Suspected Child Abuse. (LIC 9108) and Mandated Reporter Training certificate. Copy of driver’s license. Personnel Record (LIC 501) or application/resume with required information.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: WIND IN THE WILLOWS PRESCHOOL, THE	FACILITY NUMBER: 153801889
	VISIT DATE: 05/01/2023

NARRATIVE

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Pg-3 A review of staff records on today's date indicates that the Center staff, and other individuals listed on the LIC 500, Personnel Report and other personnel working at the Facility have received Criminal Record, FBI, DOJ and Child Abuse Central Index Check clearances or exemptions

Also, a review of several Children records was conducted. The review included, but was not limited to the following: Admission agreements. Needs and Services Plans for infants,. Immunization Records (“blue cards; PM 286) for non-school-age children. Authorizations for dispensing medications signed by parents. Identification and Emergency Information forms (LIC 700) Child’s Pre-admission Health History- Parents’ Report forms (LIC 702) Child’s Pre-admission Health Evaluations- Physician’s Report forms (LIC 701)
Documentation required for health-related services (e.g., blood-glucose monitoring, nebulizer care LIC 9166, gastrostomy-tube care LIC 701A and LIC 701B) Consent for Emergency Medical Treatment forms (LIC 627) 6] Unusual Incident/Injury or Death Reports (LIC 624) Parents’ Rights (LIC 995) receipts, signed and dated. Personal Rights receipts (LIC 613) are signed and dated.

At the time of the inspection, the LPA observed appropriate Staffing Ratio and Capacity: Staffing ratios per number of children in care was in compliance. LPA observed the children in care being properly care and no signs of abuse or neglect was noted. LPA observed the children in care being treated with dignity and respect. The LPA provided all information needed to ensure proper new Administrator/Director appointment. All needed documentation will be mailed to the Department no later than May 22, 2023.

Food Service The Center care providers provide the children with appropriate and safe feeding. Cleaning supplies are out of reach of children and stored separately and away from food. Food menu in the facility are not required, for they only provide nutritional snack type meals. Incidental Medical Services and drinking water lead test requirements were discussed. LPA provided assistance as to how to navigate the Public CCL web site: https://www.cdss.ca.gov/inforesources/community-care-licensing and Compliance
and Regulatory (CARE) tools and Inspection Process Project (IPP)

During today's inspection the LPA observed no deficiencies that may hinder the health and safety of the children in care; therefore, no deficiencies were cited. Overall, the Center is in compliance with Title 22 regulations. An exit Interview was conducted and a copy of this Report, and Notice of Site Visit were provided to the Facility Director.

SUPERVISOR'S NAME: Scott Herring	TELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel Rodriguez	TELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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