197412640-10-13-2021-12-CC-CHEH-C7RKWQ-20211013081620

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197412640
Report Date: 10/12/2021
Date Signed: 10/13/2021 08:16:36 AM

Document Has Been Signed on 10/13/2021 08:16 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:	NORTHLAKE HILL COMMUNITY PRESCHOOL		FACILITY NUMBER:	197412640
ADMINISTRATOR:	JACKLINE VASQUEZ		FACILITY TYPE:	850
ADDRESS:	32545 RIDGE ROUTE ROAD		TELEPHONE:	(661) 257-4560
CITY:	CASTAIC	STATE: CA	ZIP CODE:	91384
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS: 23	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:46 AM
MET WITH:	Jackeline Vasquez		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Carol Heath met with the Director Jackeline Vasquez for the purpose of conducting an unannounced Annual/Random inspection. The operating hours of the center are Monday through Friday form 7:55 am to 11:50 am. This is a preschool center. The center offers part-time admission. The facility utilizes two classrooms for the care of children labeled as classroom 1 and classroom 2. Furniture and equipment were inspected for age appropriateness and good repair. The center utilizes 3 restrooms for children under care. Age appropriate sinks and toilets were inspected for availability and good repair. All toilets, hand washing facilities were in safe and sanitary operating condition. Toilet paper and paper towels were observed inside the restrooms. Telephone service, heating, lighting and ventilation were evaluated. The LPA observed individual cubbies with children’s names. The floors and area rugs are kept clean and safe. Disinfectants, cleaning solutions, and other items that are dangerous to children are inaccessible to children. There is a clean, fully equipped kitchen (off limits) with refrigerator, freezer (1), stove and microwave oven. The facility provides a snack. A menu is posted inside the classroom. Trash bins with tight fitting lids for solid waste were observed. Uncontaminated drinking water is readily available inside the classroom from a water fountain. Allergy lists (no child with allergy) and food menus are posted in classrooms. LPA observed an appropriate amount of food and snacks. Cleaning solutions are stored separately away from the food.

Claretta Yates
Carol Heath
	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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: NORTHLAKE HILL COMMUNITY PRESCHOOL	FACILITY NUMBER: 197412640
	VISIT DATE: 10/12/2021

NARRATIVE

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The outside was inspected. There were no bodies of water observed in the playground area. The outdoor playground was inspected and was observed to be free of hazards, loose and sharp parts. There are two shaded areas for play. A water fountain is available for children to drink water from. The playground was observed to be properly gated all around. Equipment was inspected for safety, cushioning material, good repair and age appropriateness.

Children files and staff files were complete with all required licensing forms. The facility roster was up to date. The sign in and out sheet was observed inside the classroom. All staff have been fingerprinted and associated to the designated license number. There are least one center staff has currently certified in pediatric CPR and first aid. The facility had all the required licensing forms posted. The parent board was reviewed and has all of the required forms posted. LPA observed the Fire/earthquake drills current.

LPA observed a fully stocked first aid kit; fully charged fire extinguishers; carbon monoxide detectors throughout the center.

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 ADA, available at: http://www.ada.gov/childqanda.htm

The following general information was discussed during this inspection:

SUPERVISOR'S NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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: NORTHLAKE HILL COMMUNITY PRESCHOOL	FACILITY NUMBER: 197412640
	VISIT DATE: 10/12/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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. Center does not provide IMS at this time.

Mandated Reporter Training Requirements: §1596.8662 - As of January 1, 2018, child care providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. Staff was informed that they need to take mandated reporter training.

Immunization Requirements: §1596.7995 (a)(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

*All Licensing reports are available for review on-line and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code, to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.

SUPERVISOR'S NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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: NORTHLAKE HILL COMMUNITY PRESCHOOL	FACILITY NUMBER: 197412640
	VISIT DATE: 10/12/2021

NARRATIVE

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Safe Sleep Information: California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Rick-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

Fingerprint clearances and transfers: Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state licensed facility to another using form LIC 9184

The following Type B citations were issued today, H&S 1596.86621: Effective January 1, 2018, all staff of Child Care Centers and Family Child Care Homes are required to complete the Mandated Reporter Training. New staff have 90 days to complete the training. The training must be renewed every 2 years.

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

An exit interview was conducted, copies of the inspection report & Notice of Site Visit were provided to Jackeline Vasquez

SUPERVISOR'S NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/13/2021 08:16 AM - It Cannot Be Edited

Created By: Carol Heath On 10/12/2021 at 11:46 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: NORTHLAKE HILL COMMUNITY PRESCHOOL	FACILITY NUMBER: 197412640
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation,interview and record review, the teachers did not comply the Mandated Reporter Training which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/18/2021
	Plan of Correction
1 2 3 4	The director will have all the teachers take the Mandated Reporter Training this Friday 10/15/2021. The director will email LPA all the certification.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Claretta Yates

LICENSING EVALUATOR NAME:

Carol Heath

LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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