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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402355
Report Date: 09/29/2023
Date Signed: 09/29/2023 12:55:57 PM


Document Has Been Signed on 09/29/2023 12:55 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:FERNANGELES ELEMENTARY SCHOOL ROOM 9FACILITY NUMBER:
197402355
ADMINISTRATOR:JAYE, KAREN A.FACILITY TYPE:
850
ADDRESS:12001 ART STREETTELEPHONE:
(818) 767-0380
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:22CENSUS: 15DATE:
09/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Martinez, Lead TeacherTIME COMPLETED:
01:07 PM
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On Friday, September 29, 2023, at 9:30 am, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with lead teacher Maria Martinez who guided LPA Rivera.

This a State Preschool Program Title V, on Los Angeles Unified premises which takes place in room 9 at Fernangeles Elementary School. This is a full-time preschool program 7:50 am to 2:23 pm. 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, and present staff are fingerprinted cleared.



At approximately 9:43 am. LPA entered classroom 9. LPA Rivera observed 15 children with staff #1 and staff #2 present supervising the children. 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 inside storage cabinet with a child proof lock making it inaccessible for children to reach and open. LPA Rivera observed a trash bin with a lid outside by the classroom door.

Heating, lighting and ventilation were evaluated by LPA Rivera. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostat temperature to be 70 degrees. LPA observed the fire extinguisher located in classroom and the valve on the required 2A10BC fire extinguisher indicating fully charged and serviced on 4/19/2023. Smoke and carbon detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. The last emergency drill was conducted on 9/22/ 2023. LPA did not observe napping equipment. Teacher Ms. Martinez stated, the school district has not purchased the mats. First aid kit supplies are kept inside the classrooms and LPA observed the kits to be fully equipped. During this visit, per lead teacher Ms. Martinez, stated currently has no children with medication or severe food allergies. LPA Rivera asked if there were any poisons, firearms, weapons or bodies
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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: FERNANGELES ELEMENTARY SCHOOL ROOM 9
FACILITY NUMBER: 197402355
VISIT DATE: 09/29/2023
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of water. Lead teacher Ms. Martinez stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Teacher Ms. Martinez stated the ill isolation area takes place in the nurse’s office.

Restrooms are located outside the classrooms. LPA Rivera observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPA observed a total of 10 toilets, 4 urinals and 7 hand washing sinks.

At approximately 10:17 a.m. LPA Rivera entered the outdoor play area. LPA Rivera observed 4 sheds closed and locked with a keypad lock. LPA Rivera 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 Rivera observed play structure equipment to be age appropriate and areas around or under high climbing equipment, are cushioned with rubber mat that may absorb a fall. For adequate shade, LPA Rivera observed trees. LPA observed the playground yard to be fenced and the side gate and slide gate closed and locked with a keypad lock. LPA observed 1 trash bin with tight lid. For outdoor water drinking, children bring their water bottles.


This program provides breakfast and lunch. Meals are prepared onsite school cafeteria. LPA Rivera informed teacher Ms. Martinez that 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 Rivera observed water pitchers and disposable cups in the classrooms. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins. The facility was observed to be free of flies, other insects and rodents. Ms. Martinez does not know if the LAUSD has tested their water fountains for lead. Per Assistant Principal Ms. Nora Felix , she stated three of the outdoor water fountains have not been tested due to being off because they are being replaced and the other two have been tested but was not able to provide the report. LPA referred Ms. Martinez to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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 Rivera observed sign in/out sheets and observed 15 signatures.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
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: FERNANGELES ELEMENTARY SCHOOL ROOM 9
FACILITY NUMBER: 197402355
VISIT DATE: 09/29/2023
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LPA Rivera reviewed the children’s files and observed the files to be incomplete. LPA was not able to review staff file as they are in main headquarters district.

LPA Rivera observed teacher Ms. Martinez Pediatric First Aid/CPR by American Red Cross certification dated 6/23/23. Teacher Ms. Martinez has completed the mandated reporter school personnel training dated 8/13/22. Director was advised that the mandated reporter training must be completed every 2 years and is available at www.mandatedreporterca.com and the required one is AB 1207.
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.

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 and EMSA approved 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
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
Page: 6 of 9
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: FERNANGELES ELEMENTARY SCHOOL ROOM 9
FACILITY NUMBER: 197402355
VISIT DATE: 09/29/2023
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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.

Ms. Martinez 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.



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/.

Ms. Martinez 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: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
Page: 7 of 9
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: FERNANGELES ELEMENTARY SCHOOL ROOM 9
FACILITY NUMBER: 197402355
VISIT DATE: 09/29/2023
NARRATIVE
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During this visit,43 technical violations were given for not documenting emergency drills, and children files incomplete missing LIC 627 Emergency Medical Treatment and LIC 701 Physician’s Report and not providing proof of water lead testing.

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 teacher Ms. Maria Martinez.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
Page: 8 of 9