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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750032
Report Date: 05/03/2023
Date Signed: 05/03/2023 08:43:04 PM

Document Has Been Signed on 05/03/2023 08:43 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:LIFE SOURCE PREPARATORY PRESCHOOLFACILITY NUMBER:
197750032
ADMINISTRATOR:CULPEPPER, DEBERAEFACILITY TYPE:
850
ADDRESS:44709 BEECH AVETELEPHONE:
(661) 789-7663
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 31DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Preschool Director Shannon AlfordTIME COMPLETED:
08:55 PM
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On 5/3/2023 at 1:00pm, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Random Inspection. LPA was met by Preschool Director Shannon Alford and permitted to enter the facility; later Administrator Colleen Calloway joined in the inspection. Preschool Director Shannon Alford guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 31 children and 10 staff providing care and supervision. Facility operates Monday through Friday from 6:00am to 6:00pm.

Facility consists of a total of 10 rooms/areas: four classrooms, one office, one kitchen, one staff restroom, two children’s restroom, and one outdoor play area.

Indoor Activity Space:
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by each parent/guardian per requirements via a sign-in and out app on the tablet in the office. LPA observed individual storage for children's belongings. The children have access to water via filtered water in large drinking containers dispensed in individual, one-time use disposable cups and individual water bottles. An isolation area was inspected and located near the separate, staff restroom. Children are provided napping and age appropriate and individual bedding and mats were observed. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed 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 with toiletries, and sanitized by on-site staff.


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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032
VISIT DATE: 05/03/2023
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Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition. Smoke and carbon monoxide detectors are operating according to Fire Marshall standards. First Aid Kit was found to be complete with the following supplies including tweezers, scissors, gauze, bandages, cleansing pad/solution, thermometer, and a first aid manual. Trash cans with tight lids were observed. Cleaning supplies, hazardous materials, and/or poisons are found to be out of the reach of children and locked in a storage closet in the off-limits kitchen.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 4/7/2023 at 11:01am. The fire extinguisher (3A40BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 11/7/2022). Menus are posted at least a week in advanced, dated, and in sight of parents to review. Daily activity schedules are posted showing meal/snack times, nap time (if given), and specific activities. LPA observed that food allergies are noted and are posted in the off-limits kitchen on the wall, the individual classrooms on the wall, and the student’s individual folders. There is no outside food allowed and the center provides breakfast, lunch, and snacks.

Outdoor Activity Space:


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 and other play equipment were found to be securely anchored with adequate, resilient cushioning material underneath and around the perimeter. The supply shed was found to be made inaccessible with a lock. Children are provided with filtered water via a container and disposable, one-time use cups and individual drinking bottles during outdoor play. There is adequate shaded area for rest. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area.

Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined 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.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032
VISIT DATE: 05/03/2023
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Records/Documentation:
Children's records were reviewed for completeness. Health History, Identification and Emergency contact, and Medical Exams; Immunization Records are all in the children's file.
The facility roster was up to date. All staff have been fingerprinted but do not have association and clearances for five staff to the facility’s license number. Interviewed Administrator Calloway and they stated they believed they were acting in good faith in having the staff livescan but was not aware of the completing the process through Guardian website. As a result, 5 staff members were not correctly associated to the facility’s license showing any clearance status. This is a Type A Violation, see the LIC 809D for the details. This violation includes an immediate assessment of a civil penalty for $100/day upto $500 maximum per staff member without a cleared background.

The Personnel records were reviewed for completeness. Director and teachers are currently certified in Pediatric CPR/First Aid, expires until 4/2024. Child Care Providers (AB1207) Mandated Reporter training certificate is dated 9/27/2022; all staff have not completed the Mandated Reporter Training or it has expired in their file, this is a Type B Violation, see the LIC 809D for the details. There was staff without proof of the required immunizations in their file prior to the start of employment. This is a Type B violation, see the LIC 809D for the details.

Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with the 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 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.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032
VISIT DATE: 05/03/2023
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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

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

All staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 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 Hot-line at (800) 540-4000.


For additional information and forms visit our website at: www.cdss.ca.gov

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032
VISIT DATE: 05/03/2023
NARRATIVE
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For updates on Community Care Licensing, please visit the following website at: Childcareadvocatesprogram@dss.ca.gov

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

Per Title 22 Regulations, facility is not in compliance, a Type A and Type B Deficiencies have been cited. For the Type A violation, a civil penalty of $500 for each of the 5 staff members without background clearances for a total of $2500. Please, see the LIC 809D for the citations. As a Type A deficiency has been cited, a copy of the citation and licensing report must be posted for 30 days. The same report must be provided to Parents/Guardians and the Acknowledgment of Receipt of Licensing Reports LIC 9224 must be signed by Parents/Guardians of all enrolled children and any newly enrolled children in the next 12 months following the citation. If these requirements are not met, civil penalties per violation will be assessed.

An exit interview was conducted with Preschool Director Shannon Alford and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2023
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Document Has Been Signed on 05/03/2023 08:43 PM - It Cannot Be Edited


Created By: Andrea Pittman On 05/03/2023 at 07:42 PM
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: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above as Staff 1, 2, 3, 4, and 5 did not have background clearances prior to working which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/04/2023
Plan of Correction
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Staff 1, Staff 2, Staff 3, Staff 4, and Staff 5 left immediately on 5/3/2023. Staff 1, 2, 3, 4, and 5 will not return until after they have cleared background checks and associated to the facility's license.The Director will provide proof of Staff 1, 2, 3, 4, and 5 getting fingerprinted by 5/17/2023 to licensing via e-mail, fax, or mail.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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Document Has Been Signed on 05/03/2023 08:43 PM - It Cannot Be Edited


Created By: Andrea Pittman On 05/03/2023 at 07:42 PM
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: LIFE SOURCE PREPARATORY PRESCHOOL
FACILITY NUMBER: 197750032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above as the LPA observed personnel files missing the required immunizations during the record review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2023
Plan of Correction
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Licensee will provide proof of immunizations for the personnel files missing the proofs by e-mail, fax, or mail no later than 5/17/2023.
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
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above as the LPA observed personnel files missing the Mandated Reporter Certificate and expired certificates that have not yet been renewed by staff which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2023
Plan of Correction
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Licensee will provide proof of completion of the required Mandated Reporter Training and submit a copy of the current certifications for all personnel staff missing the certificate via e-mail, fax, or mail by no later than 5/17/2023.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


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