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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201899
Report Date: 09/06/2022
Date Signed: 09/08/2022 08:56:29 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/08/2022 08:56 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:LANCASTER UNITED METHODIST CHURCH PRE SCHOOLFACILITY NUMBER:
191201899
ADMINISTRATOR:DAMON, TAMMYFACILITY TYPE:
850
ADDRESS:918 WEST AVENUE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:58CENSUS: 0DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Damon TammyTIME COMPLETED:
12:30 PM
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 On 09/06/22 at 09:10 a.m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced inspection at the Lancaster United Methodist Church Preschool Facility to assess the Center's operation of their Preschool Program and current physical plant status. Also, to evaluate the Center's continuing ability to meet compliance with California Code of Regulations (CCR) Title 22, Health and Safety requirements, and other applicable State and Licensing Statutory requirements. The LPA met with the Facility Director, Tammy Damon, the purpose for the inspection and provided a copy of the Entrance checklist form, LIC 125.

The LPA was provided with copy of the Child Care Center children rosters for each classroom (LIC 9040), Personnel Report (LIC 500). The Center maintains on file a current Designation of Facility Responsibility (LIC 308), Sign in and Sign Out Rosters, current Plan of Operation and Parent Handbook. At 10:15 a.m. LPA Rodriguez along with the Director and Assistant Director, Nicole Medina conducted a walk trough of the entire Facility..The Facility consists of three collocated Facilities, this one 191201899 (pre-school program) 197411390 (Infant program) and 197411391 (school age program.)

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.

The parents board was reviewed and has all the required items posted in an area accessible to parents. The following items are posted: PUB 393, Notification of Parent’s Rights Poster; PUB 269, Child Passenger Restraint System poster; LIC 610, Emergency Disaster Plan, LIC 9148, Earthquake Preparedness form; LIC 613A, Personal Rights. The Parents Handbook is available.
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
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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