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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191223870
Report Date: 03/16/2023
Date Signed: 03/16/2023 04:00:10 PM


Document Has Been Signed on 03/16/2023 04:00 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:GRACE LUTHERAN SCHOOLFACILITY NUMBER:
191223870
ADMINISTRATOR:TERRI TURNERFACILITY TYPE:
850
ADDRESS:856 WEST NEWGROVE STREETTELEPHONE:
(661) 948-1018
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:30CENSUS: 14DATE:
03/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Administrative Assistant-Christine CalvertTIME COMPLETED:
04:15 PM
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On 3/16/2023, Licensing Program Analyst (LPA) Andrea Pittman met with Principal J Gynther and conducted an Annual Random inspection with the Administrative Assistant Christine Calvert. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 14 children and 3 Staff providing care and supervision. Facility Operates in one room referred to as Classroom 1.
Facility is located within a school with areas designated for Preschool use only. There is a total of three rooms: Classroom #1 is the classroom, one children’s bathroom, and one play area utilized for outdoor play.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed the heater was warm to the touch and accessible to children in care. The Licensee addressed it by fencing off the heater. LPA observed individual storage for children's belongings. The classroom consists of filtered water dispensers with individual one-time use disposable cups for children. An isolation area was inspected, it is in a separate area near the teacher’s desks on either side of the classroom. Children are provided a napping time and individualized mats are utilized. 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.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea PittmanTELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/16/2023
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Facility operates Monday through Friday from 6:00am to 6:00pm.

First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers were observed and in operable condition. Smoke and carbon monoxide detectors were tested and operating according to fire marshal standards. Trash cans with tight lids were observed. Additionally, LPA observed waste bins without tight fitted lids and the Licensee addressed this deficiency by moving the bins to inaccessible areas to children in care. Cleaning supplies are out of reach of children in locked cabinets.

Emergency Drills are conducted at least every 6 months and the last drill was conducted and documented on 3/16/2023 at 8:10am for both the Fire and Emergency/Earthquake Drill. The fire extinguisher (3A40BC) is reading in green and meets the Fire Marshal codes and standards (last serviced 2/5/2023). Food allergies are posted on a list prominently on the wall. There is only store-bought outside food allowed and the Center provides snacks.

The outdoor play area was inspected and observed and potential hazards of the tricycle with broken handles and cushioning on poles shifted to expose the pole in the play area. The Licensee addressed it by repositioning the pole covers and removing the tricycles. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures and other play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children are provided with filtered water via filtered water dispensers and disposable, one-time use cups or personalized water bottles during outdoor play. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.

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

DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/16/2023
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Facility maintains adequate teacher-child ratios. 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 and accessible to parents.
Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.
Director and teachers are currently certified in Pediatric CPR/First Aid which expires 9/28/2024. Child Care Providers (AB1207) Mandated Reporter training certificate has expired. A Technical Violation has been issued for the missing Mandated Reporter Trainings, Immunizations: MMR, TB, & TDAP, LIC 503- Health Screening, and complete transcripts from Staff 2 personnel file.

The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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/childqanda.htm

Upon hire 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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
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: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/16/2023
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Licensee was reminded that all staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 years. www.mandatedreporterca.com.

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. Director 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

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

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

Per Title 22 Regulations, facility is in compliance, no deficiency will be issued today. Technical violations have been issued for missing required documents from the personnel files, Licensee will follow-up to provide the missing required documents. An exit interview was conducted with Administrative Assistant Christine Calvert. 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: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023
LIC809 (FAS) - (06/04)
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