197408390-6-3-2022-12-CC-LSTN-CF2RKS-20220603130600

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408390
Report Date: 06/03/2022
Date Signed: 06/03/2022 01:06:06 PM

Document Has Been Signed on 06/03/2022 01:06 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	VAL VERDE HEAD START/STATE PRESCHOOL		FACILITY NUMBER:	197408390
ADMINISTRATOR:	JACKELINE VASQUEZ		FACILITY TYPE:	850
ADDRESS:	30249 SAN MARTINEZ ROAD		TELEPHONE:	(661) 257-9751
CITY:	VAL VERDE	STATE: CA	ZIP CODE:	91385
CAPACITY:	30	CENSUS: 0	DATE:	06/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Jackie Vasquez, Program Supervisor		TIME COMPLETED:	01:18 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/03/22, Licensing Program Analyst (LPA) Liana Stepanyan, met with program supervisor Jackie Vasquez, to conduct an unannounced annual random inspection for the preschool program. Upon arrival, LPA did not observe any children in care. The facility provides a half day program from 8:30am to 12pm and is part of Castaic Union School District. The facility roster was up to date and all staff have been fingerprinted and associated to the designated license number. Program Supervisor and teacher are currently certified in Pediatric CPR/First Aid valid through 02/2023. During the inspection, LPA observed the parent board located outside the classroom with all the required forms posted accessible to parents. LPA also review the sign in/out sheet to verify current census of children. Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean, cleaning compounds inaccessible, poisons locked, furniture/equipment 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. Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors. All materials and surfaces are toxic free, there is centralized heating and air conditioning, window screens are in good repair and free of debris.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VAL VERDE HEAD START/STATE PRESCHOOL	FACILITY NUMBER: 197408390
	VISIT DATE: 06/03/2022

NARRATIVE

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There is a working Carbon monoxide detector, smoke detector and Fire Extinguisher (2A10BC). There is three toilet and three handwashing fixtures for children which are safe and sanitary operating condition. The facility also has working telephone service on the premises. There is an isolation area for children who become ill while in care is located next to the kitchen, facility maintains a comfortable temperature at all times, first aid supplies (thermometer, bandages, scissors) is located in the classroom and outside of the bathroom. Smoking prohibited on the premises, daily inspection for illness is conducted by staff, no prohibited childcare items observed. Firearms/weapons are not allowed or stored on premises.

The outdoor play areas were inspected and observed to be free of hazards, loose, or sharp objects. Program Supervisor mentioned they are in process of getting new playground installed. Current equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures other large play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children bring their own water bottles with labels and facility has drinking fountains available for refills indoors and outdoors. 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.

Medications inaccessible to children; all prescription and nonprescription medications have child’s name and are dated; written consent and instruction from child’s representative; a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).

This facility provides Incidental Medical Services – IMS.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VAL VERDE HEAD START/STATE PRESCHOOL	FACILITY NUMBER: 197408390
	VISIT DATE: 06/03/2022

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Program Supervisor 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 family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

No deficiencies were observed at the time of the visit.

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

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview conducted, copy of this report was reviewed and provided to program supervisor.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana Stepanyan	TELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2022

LIC809 (FAS) - (06/04)

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