197413996-12-6-2023-12-CC-IORA-CY9T8Z-20231206133111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197413996
Report Date: 12/06/2023
Date Signed: 12/06/2023 01:31:28 PM

Document Has Been Signed on 12/06/2023 01:31 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:	VOA GRANTEE/PACOIMA HEAD START		FACILITY NUMBER:	197413996
ADMINISTRATOR:	CASTILLO, ANGELICA		FACILITY TYPE:	850
ADDRESS:	12550 VAN NUYS BLVD		TELEPHONE:	(818) 834-8957
CITY:	PACOIMA	STATE: CA	ZIP CODE:	91331
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 11	DATE:	12/06/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elena Rieger, Teacher Supervisior		TIME COMPLETED:	12:45 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 12/06/2023 Licensing Program Analyst (LPA) Isabel Ortega met with Teacher Supervisor and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 11 children and three staff providing care and supervision. Facility Operates in one classroom referred to as the Class room One. There is a total of one classroom, one play yard and four sheds in the outdoor play yard (maintained locked with key pad) and utilized for equipment storage. A emergency supply bin is on the premises. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed individual storage with children’s name labeled for children's belongings. The classroom consists of filtered water for indoor and outdoor use individual disposable cups for children are available. For outdoor drinking water facility has water igloos available for children. An isolation area was inspected, which takes place in the office space and a mat is provided.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: VOA GRANTEE/PACOIMA HEAD START	FACILITY NUMBER: 197413996
	VISIT DATE: 12/06/2023

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Emergency Drills are conducted every month last drill was conducted and documented on 12/05/2023 at 10:00 a.m. The fire extinguisher (2A10BC) is reading in green and meets the Fire Marshal codes and standards (last serviced 11/03/2023).

The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Climbing structures 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 in igloo containers with disposable cups available for children for indoor and outdoor play. The facility provided lead testing results under 5.5 ppb. which meets the PIN 21-21 regulations.

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.
Facility maintains adequate teacher child ratio. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. The parent board was reviewed and has all the required forms posted 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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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: VOA GRANTEE/PACOIMA HEAD START	FACILITY NUMBER: 197413996
	VISIT DATE: 12/06/2023

NARRATIVE

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Teacher Supervisor and teachers are currently certified in Pediatric CPR/First Aid which expires until 06/21/2025. Child Care Provider Mandated Reporter (AB1207) training is dated 10/06/2023.

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

All staff are required to take 3-hour Child Care Provider Mandated Reporter training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: VOA GRANTEE/PACOIMA HEAD START	FACILITY NUMBER: 197413996
	VISIT DATE: 12/06/2023

NARRATIVE

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During nap time children are provided with cots. The blankets and sheets are provided by the facility and parents take them home weekly for wash. Children have the option for rest time and quiet time if needed, comfortable privacy areas are available. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flush 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 of toiletries, and sanitized by facility custodian and staff disinfect daily and or as needed.

Facility offers one educational session Monday through Friday from 8:15 a.m. to 2:30 p.m. Facility participates in the Food Nutrition program and provides children with breakfast, lunch and afternoon snack. Menu is posted visible to parents and copies are available per request. Food allergies are noted in the classroom and food preparation area.
Facility had all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, carbon monoxide(dual)Tested 11:05 a.m. and fire extinguishers(serviced 11/3/23) were observed and in operable condition according to fire marshal standards.

Trash cans with tight lids were observed. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature, and there is hot running water in the food preparation area.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: VOA GRANTEE/PACOIMA HEAD START	FACILITY NUMBER: 197413996
	VISIT DATE: 12/06/2023

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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 deficiencies will be issued today. An exit Interview was conducted with facility Teacher Supervisor. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC809 (FAS) - (06/04)

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