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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418481
Report Date: 09/19/2022
Date Signed: 09/28/2022 10:55:41 AM


Document Has Been Signed on 09/28/2022 10:55 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:PACOIMA CHARTER SCHOOLFACILITY NUMBER:
197418481
ADMINISTRATOR:FAJARDO, SYLVIAFACILITY TYPE:
850
ADDRESS:11016 NORRIS AVETELEPHONE:
(818) 899-0201
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY:92CENSUS: 50DATE:
09/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Sylvia Fajardo and Angela TilghmanTIME COMPLETED:
06:00 PM
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On 09/19/2022 Licensing Program Analyst Isabel Ortega met with Administrator Sylvia Fajardo and Director Angela Tilghman and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. At time of entry LPA observed 50 children in care and 9 staff in the classrooms. There is a total of four classrooms, per facility Classroom #2 is not being utilized at this time.
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. Each classroom consist of filtered water containers with labelled water bottles for children. An isolation area is available in case a child begins to show Covid-19 symptoms, which will take place in room #40(supervision will be provided). Children are provided with a cot for nap time. Age appropriate sinks, urinals and toilets were inspected for availability and good repair for the exception of one sink in the boys restroom(slow water flow( according to facility sink is in the process of being repaired). Toilets flush properly; toilet, urinal and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms were found to be clean and sanitary.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PACOIMA CHARTER SCHOOL
FACILITY NUMBER: 197418481
VISIT DATE: 09/19/2022
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First Aid kit with digital thermometer was observed in each classroom. Smoke detectors, carbon monoxide and fire extinguishers(serviced 8/9/22) were observed and in operable condition. Trash cans with tight lids were observed. The center provides food for the children enrolled. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. There is hot and cold running water in the kitchen/food preparation area. Food preparation area is adequately equipped, clean, and free from hazards. Cleaning supplies are out of reach of children and stored separately and away from food. Food allergies are noted per classroom and are posted in the preparation area and in each classroom. Staff's Safe Service certificate is valid and expires 4/10/2024. Menu is posted for parent review.

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. The outdoor area has a working water fountains (due to pandemic water fountains are not currently being utilized by children). Children are provided with filtered individual water bottles. 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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PACOIMA CHARTER SCHOOL
FACILITY NUMBER: 197418481
VISIT DATE: 09/19/2022
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During the inspection LPA observed adequate teacher child ratio in each classroom. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. A review of the sign in/out sheet was conducted to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents. First Aid kit with digital thermometer was observed in each classroom. Smoke detectors, carbon monoxide and fire extinguishers(serviced 8/9/22) were observed and in operable condition. Trash cans with tight lids were observed. The center provides food for the children enrolled. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. There is hot and cold running water in

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file (blue cards will be requested by the department of Public Health and placed in child’s file). The facility roster was up to date.

All staff have been fingerprinted and association to the designated license number. Staff files were reviewed with Human Resource Department for qualifications and documentation required by Title 22 regulations. Director and teachers are currently certified in Pediatric CPR/First Aid which expires on 03/02/2024.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PACOIMA CHARTER SCHOOL
FACILITY NUMBER: 197418481
VISIT DATE: 09/19/2022
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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

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

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 Hotline at (800) 540-4000.



LPA went over 2023 lead requirements.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
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: PACOIMA CHARTER SCHOOL
FACILITY NUMBER: 197418481
VISIT DATE: 09/19/2022
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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.

No deficiencies were observed at the time of inspection advisories were provided as preventative. Per Title 22 regulations facility was not cited today.

An exit Interview was conducted with Administrator and Director, a copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5