197750022-5-3-2022-12-CC-CHEH-CE3NJG-20220503103020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750022
Report Date: 05/02/2022
Date Signed: 05/03/2022 10:30:32 AM

Document Has Been Signed on 05/03/2022 10:30 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:	ANTELOPE ELEMENTARY SCHOOL		FACILITY NUMBER:	197750022
ADMINISTRATOR:	LUNA, JESUS		FACILITY TYPE:	850
ADDRESS:	37237 NORTH 100TH STREET EAST		TELEPHONE:	(661) 944-2148
CITY:	LITTLEROCK	STATE: CA	ZIP CODE:	93543
CAPACITY:	48	CENSUS: 18	DATE:	05/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:12 AM
MET WITH:			TIME COMPLETED:	12:30 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 Site Director Terry Walker, to conduct an Annual random inspection of the preschool school. During this inspection, LPA toured the center indoors and outdoors according to the facility sketch. This facility is a combination center with a school-age component. This center is located on a public school site Antelope Elementary School and belongs to Keppel Union School District. There is physical separation between the public school and the child care center. The Center has relocated the prior classroom into 2 bungalow classrooms. 2 classrooms will be used for the preschool, rooms 1 and 2. LPA's measured classrooms # 1 and 2. The facility operates from 8:30 am to 11:30 pm (AM section), from 12:30 pm to 3:30 pm (PM section) (Monday - Friday). Incidental Medical Services (IMS) were discussed. · Classrooms: In each classroom, LPAs observed age-appropriate furniture, equipment, toys, and materials. The classroom was observed to be clean, safe, and free of any health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. There are cubbies in which children can store their belongings. LPAs observed water dispensers (jugs) and disposable cups for drinking water in each classroom. · Medications: Medications are stored in a locked storage cabinet in the director's office. · Fire Extinguisher and Smoke Detector/Carbon Monoxide: The facility has an intercom system and surveillance video on the premises, which covers each classroom and outside play area. A fire extinguisher and Smoke detector/carbon monoxide detector were observed and tested in each classroom by LPAs. · Bathrooms: LPAs inspected and observed the children's bathrooms. Classroom 1 has 2 toilets and 3 sinks inside the classroom. Toilets and sinks are functioning properly and are age-appropriate. Staff uses a separate bathroom located across the yard. Classroom 2 has 2 toilets and 3 sinks inside the classroom. Toilets and sinks are functioning properly and are age-appropriate. LPAs observed soap, toilet paper and paper towels were readily available.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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: ANTELOPE ELEMENTARY SCHOOL	FACILITY NUMBER: 197750022
	VISIT DATE: 05/02/2022

NARRATIVE

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· Outdoor: Outdoor play equipment was inspected for health, and safety, the playground consists of sand material that will provide cushioning in the event a child falls. The outdoor play area is toured and the yard is completely fenced. The outdoor play yard continues to use an alternated outdoor playtime for the Preschools and the Kindergarten children. The sand is (raked daily) and was observed to be clear and free of debris. LPAs observed large and small play structures are securely anchored to the ground. There is a shaded canopy over the play structures and adequate shade. Drinking water is available with a drinking fountain. The play area was inspected for hazards and inaccessibility to bodies of water.
· Daily Check-in: Children are inspected for illnesses as they arrive. A review of medication policy indicated that prescription medication is administered only with the parent's written permission. The Director or the Administrator Coordinator administers the medication and documents the dosage, date, and time onto a log. Medication is brought and taken home by the parent daily or retained in a locked cabinet (director office) or a refrigerator (director office) properly labeled. Medication is properly labeled and stored in its original container.
· Menus are posted in the office. Allergy lists are posted in each classroom and main office. LPAs observed an appropriate amount of food and snacks. The chemicals are kept separate from the food. The facility has ensured and established measures to keep the facility free of flies and other insects or rodents.
· Fire Extinguisher: There is an operating telephone in the Child Care Center. LPAs observed fully charged and operational 2:10ABC fire extinguisher (Date: 7/13/21) located in each classroom. This facility has one or more functioning carbon monoxide detectors that meet statutory requirements. All storage containers for solid waste, including moveable bins, have tight-fitting covers that are kept on and are in good repair.
· Teacher child ratios were observed and care and supervision were evaluated to determine if the basic needs of children are appropriately met. 1 teacher and 1 TA for each classroom
· Sign-in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Fire/earthquake drills current. Children's records and staff records were reviewed.
· CPR/First Aide: The center has 2 staff are currently certified in pediatric CPR and first aid.
· Children's files and Staff files were complete with all required licensing forms. The facility roster was up to date. LPA observed 10 children and 6 staff files.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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: ANTELOPE ELEMENTARY SCHOOL	FACILITY NUMBER: 197750022
	VISIT DATE: 05/02/2022

NARRATIVE

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· Fingerprint clearances: All staff has been fingerprinted by the school.
· Licensing Forms: The facility had all the required licensing forms posted. The parent board was reviewed and has all of the required forms posted.
· Fire/Earthquake Drills: LPA observed the Fire/earthquake drills current. School practiced every month.
The following general information was discussed during this inspection:

The incidental Medical Services (IMS) policy was discussed. The 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
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.
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	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

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: ANTELOPE ELEMENTARY SCHOOL	FACILITY NUMBER: 197750022
	VISIT DATE: 05/02/2022

NARRATIVE

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Safe Sleep
LPA discussed the safe sleep regulations with the licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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. Child Care Centers: Licensee [or facility representative] was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.
There were no citations issued during today's inspection.
Exit Interview
Exit interview conducted and report was reviewed with the facility representative Terry Walker.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2022

LIC809 (FAS) - (06/04)

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