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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808741
Report Date: 08/17/2023
Date Signed: 08/17/2023 04:31:17 PM


Document Has Been Signed on 08/17/2023 04:31 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:ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUSFACILITY NUMBER:
153808741
ADMINISTRATOR:ROSIE MARIE BORQUEZFACILITY TYPE:
850
ADDRESS:300 FRANKLIN STREETTELEPHONE:
(661) 854-6560
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:24CENSUS: 8DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Angelica SalinasTIME COMPLETED:
02:30 PM
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On 08/17/2023, Licensing Program Analyst (LPA) Beneroso met with the Lead Teacher, Dolores Valadez, for the One Year Required inspection for the preschool license in accordance with the facility sketch. Program Director, Angelica Salinas arrived shortly after. A tour of the facility was conducted. Upon arrival, LPA observed 8 children present, one teacher and one teacher aide on the premises providing care and supervision. The hours of operation are Monday – Friday, 7:55AM – 10:55 AM for first shift and 11:30AM – 02:30PM for the second shift. Incidental Medical Services (IMS) were discussed.

Indoor/Children’s Area:
There is currently one classroom operating in the facility. The classroom was observed to be clean, safe, sanitary and in good repair; floors of the room have a surface that is safe and clean. Cleaning compounds are made inaccessible, they are located in an upper shelf. Furniture/equipment in the classroom is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, and personal belongings. There is an assigned area for sick/ill children in the nurse’s office located in the school campus. All indoor passageways, stair ways, incline, ramps, open porches, and other areas of potential hazard are kept free of obstruction. There is a working telephone on the premises.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 08/17/2023
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Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors. Drinking water is available inside the classroom in the form of filtered water from a dispenser to fill up each child’s personal water bottle. There is a working Carbon monoxide detector, smoke detector and Fire Extinguisher (3A40BC).

Teacher child ratios were observed to be appropriate, and staff name recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.



Health Related Services/IMS: This facility does not currently provide Incidental Medical Services – IMS. 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/childquanda.htm

Food Service: Meals served include Breakfast, and snacks for the AM Shift. Lunch and PM Snack is provided for the afternoon shift. The facility receives the food from the school’s cafeteria. Menus were posted in a prominent place. There are no children with allergies currently enrolled.

Restrooms: LPA inspected and observed two restrooms and they were found to be in operable condition, however, LPA observed all three toilets to be unclean. A type B Violation was cited for this deficiency. LPA observed soap, toilet paper and paper towels readily available. Water temperature is appropriate. Facility maintains a comfortable temperature at all times.



Napping: The facility runs a half day program; children do not nap.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 08/17/2023
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Outdoor: Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. The facility has one playground/outdoor area for the children. Outdoor play structure was observed not to be in good repair and condition. There is a slide in the play structure that was observed to be broken and boarded up inappropriately. Children have access to the play structure, which poses a potential safety risk for children. A type B Violation was cited for this deficiency. Outside play area is completely fenced. There is turf, concrete, and rubber surface areas for active play. No bodies of water were observed. There are areas for shade and rest. Facility provides water when children play outside in children’s personal water bottles that are refilled with filtered water.

Children/Personnel Records: Staff qualifications were verified. Staff files were observed to be complete. Children’s files were observed to be incomplete. Documents missing included: Notification of Parent’s Rights Receipt, Consent for Emergency Medical Treatment and Personal Rights. A Type B Violation was issued for this deficiency.



Facility Records: Roster, sign in and out sheets and fire/disaster drill log (completed on 08/11/2023) were also observed to be maintained as required.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, earthquake preparedness checklist.


Advisory/Other: LPA did not observe First Aid Kit in the classroom. A Type B Violation was issued for this deficiency. CPR/First Aid expires on 07/29/2024. Proof of Mandated Reporter will be sent to LPA no later than 08/18/2023. Electrical outlets are inaccessible, recalled and or prohibited toys or sleep/play equipment were not observed on the premises. There are no window cords accessible to children. No Smoking on premises, daily inspection for illness are conducted, no prohibited items observed. Firearms/weapons are not allowed or stored on premises.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 08/17/2023
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Program Director was advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm

Program Director was reminded that all adults 18 and over, 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.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l


Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Site Supervisor shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 08/17/2023
NARRATIVE
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There were 4 Type B citations issued during today’s inspection. Exit interview conducted and report was reviewed with Program Director, Angelica Salinas. A copy of this report was provided electronically along with her appeal rights and Notice of Site Visit. A notice of site visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 08/17/2023 04:31 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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(d)
Health-Related Services
(d) The licensee shall maintain the following first-aid supplies in a location accessible to staff but inaccessible to children:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the licensee did not comply with the section cited above. There was no First Aid Kit in the classroom, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Program Director will send proof (picture) of complete First Aid Kit to LPA Beneroso
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 to be unclean, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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LPA observed custodial staff clean the toilets during visit
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: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 7


Document Has Been Signed on 08/17/2023 04:31 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: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(o)(1)
Fixtures, Furniture, Equipment and Supplies
(o) Playground equipment shall be securely anchored to the ground unless it is portable by design. (1) Equipment shall be maintained in a safe 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 and interview the licensee did not comply with the section cited above. LPA observed play structure with a broken slide and boarded inappropiately, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/17/2023
Plan of Correction
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LPA observed the slide that is broken and boarded inappropiately made inacessible to children during visit. Program Director sent a work order during visit.
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review the licensee did not comply with the section cited above. LPA observed 2 children's files to be incomplete, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/21/2023
Plan of Correction
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Program Director will send proof (pictures) of complete forms to LPA Beneroso by 08/21/2023
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: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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