197750022-12-13-2023-12-CC-CHEH-CYGQW8-20231213113131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750022
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:31:47 AM

Document Has Been Signed on 12/13/2023 11:31 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: 28	DATE:	12/13/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Renee Varney		TIME COMPLETED:	11:45 AM

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 12/13/2023, Licensing Program Analysts (LPAS) Carol Heath and Crystal Ali met with the Preschool Instructor, Renee Varney, to conduct an unannounced Annual/Random inspection. LPAs disclosed the purpose of the inspection and was granted entry to the facility. During this inspection, LPAS toured the center indoors and outdoors, according to the facility sketch. 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 childcare center. The Center has relocated the prior classroom into 2 bungalow classrooms. 2 classrooms will be used for the preschool, rooms 1 and 2. LPAS Heath inspected classrooms # 1 and 2. The facility operates from 8:45 am to 11:20 pm (AM section) and from 12:45 pm to 3:20 pm (PM section) (Monday - Friday). Incidental Medical Services (IMS) were discussed. Physical Plant: LPAS toured and inspected the preschool classrooms. Furniture and equipment were checked for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPAs observed age-appropriate toys and materials. Daily activities schedule was observed in each classroom. Drinking water is available inside the classrooms in the form of disposable plastic cups and water jugs. A fire extinguisher (checked 6/10/2023), a smoke detector, and a carbon monoxide detector are on the premises. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on; they shall be leakproof and rodent-proof.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 12/13/2023

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Bathrooms: LPAS inspected and observed the children's bathrooms. Classroom 1 has 2 toilets and 3 sinks inside the classroom. The toilets and sinks function properly and are age appropriate. Staff use a separate bathroom located across the yard. Classroom 2 has 2 toilets and 3 sinks inside the classroom. The toilets and sinks function properly and are age appropriate. LPAS observed that soap, toilet paper, and paper towels were readily available.
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 be used as an alternate outdoor play area for the preschool and 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 with a no-touch thermometer and an overall wellness check. A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The Director and other administration staff administer medication and document the dosage, date, and time on a log. Medication is brought and locked at the center (unless the parent requests daily return). Medication is labeled correctly and stored in its original container. Medication is kept at the center until expiration and sent home with the parent for disposal. There are currently no children in care with IMS needs. The director's office has a separate area for isolating and caring for ill children. There is a mat available for ill children. An isolated toilet and sink are available in the staff restroom for ill children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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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: 12/13/2023

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A Fire Drill/Earthquake log is posted in the office. The preschool classrooms are following school Fire Drill schedule. The center conducted disaster drills for at least 6 months. A current Roster is available.
Fire Extinguisher: There is an operating telephone in the Child Care Center. LPAs observed a fully charged and operational 2A10BC fire extinguisher located in each classroom. This facility has one or more functioning carbon monoxide detectors that meet statutory requirements.
LPAS observed a first aid kit. LPAS provided a First aid supplies list to the Director.
The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Sign-in and out sheets were reviewed. The Teacher-to-child ratio was observed, and staff names were recorded. Care and supervision were evaluated to determine if the children’s basic needs were met and appropriate.
Staff Records/Children's Records: LPAS observed 10 children and 4 staff files. Staff records were reviewed. LPAS verified there is at least 1 staff person present with current CPR and First Aid Training. All staff complete the Mandated Reporter training every 2 years. All staff receives Measles, Pertussis, and Influenza vaccination. All staff have requested fingerprinting associated with the facility. Children's files were complete with all required licensing forms. The facility roster was up to date.
Food Service: The food is from school kitchen. The facility provides breakfast, lunch, and a PM snack. Allergy lists are posted in the classrooms. LPAs observed an appropriate amount of food and snacks and staff preparing lunch (with gloves). LPAs observed that food preparation and storage areas are kept clean and free of litter and rubbish. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. Menus are posted at least one week in advance and made available for review by the parents.
Menus are posted in the classroom. Allergy lists are posted in each classroom. LPAs observed an appropriate amount of food and snacks.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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

FACILITY NAME: ANTELOPE ELEMENTARY SCHOOL	FACILITY NUMBER: 197750022
	VISIT DATE: 12/13/2023

NARRATIVE

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The following general information was discussed during this inspection:

· 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Center does not provide IMS at this time.
· As of January 1, 2018, childcare providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided according 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.
· §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare 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 online 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: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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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: 12/13/2023

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· 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
· Before working or volunteering in a licensed childcare 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
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of the report documenting a Type A Citation and sign form LIC 9224 acknowledging receipt. Staff is aware of the required forms for children's files and forms that shall be posted after licensure.
· Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

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

FACILITY NAME: ANTELOPE ELEMENTARY SCHOOL	FACILITY NUMBER: 197750022
	VISIT DATE: 12/13/2023

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· Center Director advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations and quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation about exemptions and Parent’s Rights was also discussed.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

Exit interview conducted and report was reviewed with the Preschool Instructor, Renee Varney.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/13/2023 11:31 AM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above. LPAs observered 10 children files and only 5 children have TB and PR (LIC 701), which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2024
	Plan of Correction
1 2 3 4	The teacher will review their children's file and ask parent to complete LIC 701 with their doctor. After teacher received LIC701, she will email to LPA.

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	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol Heath	TELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2023

LIC809 (FAS) - (06/04)

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