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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202079
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:24:18 PM


Document Has Been Signed on 08/17/2023 01:24 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SMALL WORLD NURSERYFACILITY NUMBER:
191202079
ADMINISTRATOR:MILLER, LINDAFACILITY TYPE:
850
ADDRESS:26640 NORTH BOUQUET CANYON RDTELEPHONE:
(661) 296-1155
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:85CENSUS: 8DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Amy Dell, Lead Teache4rTIME COMPLETED:
01:34 PM
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On Thursday, August 17, 2023, at 8:53 am, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced inspection and met with lead teacher Amy Dell who guided LPA Rivera on a tour of the facility.

This is a preschool program at serves children ages 3 to 5 years. This program operates Monday to Friday 7:00 a.m. – 5:30 p.m. Sign in and out takes place at the main entrance area. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were observed.



At approximately 9:05 a.m. LPA entered classroom 6. LPA Rivera observed the classroom to be unoccupied due to low enrollment. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored on top of a 5ft shelve making it inaccessible for children to reach. LPA Rivera observed a step trash bin with a lid in the classroom and the bottom sink cabinets closed and key locked.

At approximately 9:12 a.m. LPA entered classroom 5. LPA Rivera observed the classroom to be unoccupied due to low enrollment. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored on top of a 5ft shelve making it inaccessible for children to reach. LPA Rivera observed a step trash bin with a lid in the classroom and the bottom sink cabinets closed and key locked.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 08/17/2023
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At approximately 9:17 a.m. LPA entered classroom 4. LPA Rivera did not observe the children in the classroom. Children were outside for outdoor play time. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored on top of a 5ft shelve making it inaccessible for children to reach. LPA Rivera observed a step trash bin with a lid in the classroom and the bottom sink cabinets closed and key locked.

At approximately 9:25 a.m. LPA entered classroom 3. LPA Rivera did not observe the children in the classroom. Children were outside for outdoor play time. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed a cubby for children to store their personal belongings. LPA observed cleaning solutions stored on top of a 5ft shelve making it inaccessible for children to reach. LPA Rivera observed a step trash bin with a lid in the classroom and the bottom sink cabinets closed and key locked.

Heating lighting and ventilation were evaluated by LPA Rivera. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostats located in classrooms and temperatures to be between 71-72 degrees. LPA observed the fire extinguishers located in classrooms and the valve on the required 2A10BC fire extinguishers indicating fully charged and serviced on 10/6/2022. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm. Carbon monoxide detectors are in classrooms. LPA tested the carbon monoxide detectors and are operable. Last emergency drill was conducted on 5/10/2023. LPA observed napping equipment cots to be in good condition. First aid kit supplies are kept inside the classrooms and LPA observed the kits to be fully equipped. During this visit, per lead teacher currently no children with medication or severe food allergies. LPA Rivera asked if there are any poisons, firearms, weapons or bodies of water. Lead teacher Amy stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Lead teacher Amy Dell stated the ill isolation area take place in the director’s office and utilize restroom located in the director’s office.

Classroom 6 and 5 share restroom and located in between both classrooms. Classroom 4 and 3 share restroom and located in between both classrooms. LPA observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPA observed a total of 2 toilets and 6 hand washing sinks.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 08/17/2023
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At approximately 9:36 a.m. LPA entered the outdoor play area to conduct and inspection. LPA observed a total of 8 preschool children present with Staff 2 and 4 present. LPA observed 1 shed closed and locked with a keylock. LPA observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA observed play equipment to be age appropriate and areas around or under high climbing equipment, are cushioned with sand that may absorb a fall. For adequate shade, LPA observed 2 E-Z up canopies. LPA advised to anchor or place weight to hold down the E-Z up canopies. LPA also advised to rake the sand to ensure there is no hazards in the sand. For outdoor water drinking, LPA observed children water bottles with their names. Lead testing was conducted on 9/27/2022.

This program does not provide snacks or meals. LPA informed lead teacher Amy any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA observed water bottles and water pitchers in the classrooms. The facility was observed to be free of flies, other insects and rodents.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA observed sign in/out sheets and observe 8 signatures.

LPA reviewed children and staff files, and Child Care Facility Roster.

LPA observed director Michelle Moyer Pediatric First Aid/CPR certification dated 5/21/22, and director has proof of immunization against Pertussis, MMR and Influenza declination. Director has completed the mandated reporter (AB 1207) training dated 9/8/2021. Director was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

Items discussed during this visit:

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 08/17/2023
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3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR must be present.
6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.



Director Michelle Moyer was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 08/17/2023
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with director Michelle Moyer and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed director Michelle Moyer 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 PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Director Michelle Moyer was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SMALL WORLD NURSERY
FACILITY NUMBER: 191202079
VISIT DATE: 08/17/2023
NARRATIVE
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One technical violation was given during this visit for not having Emergency Services Medical Authority (EMSA) stickers on the Pediatric First Aid/CPR certifications. During this visit, director called trainer Tamar Andrews who instructed the course utilizing the curriculum provided by Medic First Aid. Trainer Tamar stated that she will be issuing the EMSA stickers on Monday 8/21/23.

A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with director Michelle Moyer.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
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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