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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808551
Report Date: 04/27/2023
Date Signed: 04/27/2023 06:31:12 PM


Document Has Been Signed on 04/27/2023 06:31 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:FALLER STATE PRESCHOOLFACILITY NUMBER:
153808551
ADMINISTRATOR:MICHELLE A ARMSTRONGFACILITY TYPE:
850
ADDRESS:1500 WEST UPJOHNTELEPHONE:
(760) 499-1694
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:24CENSUS: 22DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Site Supervisor Lizet RoblesTIME COMPLETED:
06:40 PM
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On 4/27/2023 at 1:48pm, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Random Inspection. LPA was met by Site Supervisor Lizet Robles and permitted to enter the facility. LPA toured the facility in accordance with the facility sketch with Site Supervisor Lizet Robles and Program Director Michelle Armstrong. During the inspection, LPA observed twenty two children and five staff providing care and supervision. Facility operates Monday through Friday from 7:30am to 4:30pm.

Facility consists of a total of 6 rooms: one classroom, one office, one kitchen, one staff bathroom, one children’s bathroom, and one outdoor play area.

Indoor Activity Space:
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by each parent/guardian per requirements. LPA observed individual storage for children's belongings. The children have access to water via individual water bottles and the water bubbler in the classroom. An isolation area was inspected by the Staff’s restroom and the Staff’s restroom is the separate restroom accessible for children in isolation. Children are not provided napping but has a calming/resting area for children, if needed. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff. The facility has not had lead testing on the water bubbler in the classroom which is being used by the children in care; additionally, the two water bubblers in the outdoor play area have not yet been tested for lead, either. This is a Type B Violation, see the LIC 809D for details.

Continue to next pages.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
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: FALLER STATE PRESCHOOL
FACILITY NUMBER: 153808551
VISIT DATE: 04/27/2023
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Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition. Smoke and carbon monoxide detectors are operating according to Fire Marshall standards. First Aid Kit was found to be complete with the following supplies including tweezers, scissors, gauze, bandages, cleansing pad/solution, thermometer, and a first aid manual. Trash cans with tight-fitted lids were observed. Cleaning supplies, hazardous materials, and/or poisons are found to be out of the reach of children and locked in a cabinet above the kitchen sink.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 3/22/2023 at 10am for the morning class and 2pm for the afternoon class. The fire extinguisher (3A40BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 6/18/2022). Menus are posted at least a week in advanced, dated, and in sight of parents to review. Daily activity schedules are posted showing meal/snack times, and specific activities. Food allergies are noted and are posted in the kitchen on the refrigerator. There is outside food allowed via children bringing their own lunches and store-bought food only and the center provides breakfast, lunch, and no snacks that is prepared in the Elementary School's Kitchen.

Outdoor Activity Space:


The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. This is a State Preschool which shares an outdoor play area with the State Elementary School. Site Supervisor Lizet Robles completed a Declaration acknowledging that there is school-age equipment in the outdoor play area and they will utilize 100% Care and Supervision in not allowing the children to have access to the school-age climbing structure, monkey bars, and swings. Climbing structures and other play equipment for the preschool age children in care were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children are provided water via individual drinking bottles or the two water bubblers during outdoor play. There is adequate shaded area for rest. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area.

Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met. The parent board was reviewed and has all the required forms posted accessible to parents.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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: FALLER STATE PRESCHOOL
FACILITY NUMBER: 153808551
VISIT DATE: 04/27/2023
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Records/Documentation:
Children's records were reviewed for completeness. Health History, Emergency Contact, Medical Exams, Immunization Records, and required forms are all in the children's file.
Personnel records were reviewed for completeness and the Mandated Reporter and Pediatric First Aid & CPR certifications were present and current for required staff. LPA observed Staff 1 providing care and supervision to children in care but is not associated to facility in Guardian and does not have an “Eligible” background clearance status. This is a Type A Violation, see the LIC 809D for the details. Site Supervisor is currently certified in Pediatric CPR/First Aid, which expires 06/18/2023. Child Care Providers (AB1207) Mandated Reporter training certificate is dated 6/22/2022.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with the facility representative 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 facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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

Upon hired date, all staff are required to be immunized and show proof of immunization records according to Title 22 regulations.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
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: FALLER STATE PRESCHOOL
FACILITY NUMBER: 153808551
VISIT DATE: 04/27/2023
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All staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 years. Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Site Supervisor is aware self and all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot-line at (800) 540-4000.


For additional information and forms visit our website at: www.cdss.ca.gov

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.

For updates on Community Care Licensing, please visit the following website at: Childcareadvocatesprogram@dss.ca.gov



A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations, this facility is not in compliance, a Type A and Type B Deficiency has been cited. Please, see the LIC 809D for the citations. As a Type A deficiency has been cited, a copy of the citation and licensing report must be posted for 30 days. The same report must be provided to Parents/Guardians and the Acknowledgment of Receipt of Licensing Reports LIC 9224 must be signed by Parents/Guardians of all enrolled children and any newly enrolled children in the next 12 months following the citation. If these requirements are not met, civil penalties per violation will be assessed.

An exit interview was conducted with Site Supervisor Lizet Robles and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/27/2023 06:31 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: FALLER STATE PRESCHOOL
FACILITY NUMBER: 153808551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above by not having Staff 1 have an eligible criminal record clearance prior to starting employment which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/28/2023
Plan of Correction
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Staff 1 left the center immediately on 4/27/2023. Staff 1 will not return until there is an eligible criminal record clearance prior to returning and will provide Licensing with proof of clearance via fax or e-mail by 5/11/2023.
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: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 04/27/2023 06:31 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: FALLER STATE PRESCHOOL
FACILITY NUMBER: 153808551

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above as the Program Director disclosed that the lead testing has not been completed since 2019 for the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/11/2023
Plan of Correction
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The Licensee will provide the LIC 9275, LIC 9276, and Facility Sketch associated to the lead testing once it has been completed. Licensee will submit these documents via e-mail or fax by 5/11/2023.
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: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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