263801648-5-24-2024-12-CC-CALI-D5KR5L-20240524124319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 263801648
Report Date: 05/24/2024
Date Signed: 05/24/2024 12:43:37 PM

Document Has Been Signed on 05/24/2024 12:43 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	IMACA COLEVILLE PRESCHOOL		FACILITY NUMBER:	263801648
ADMINISTRATOR:	TAMMY NGUYEN		FACILITY TYPE:	850
ADDRESS:	111527 HIGHWAY 395		TELEPHONE:	(760) 873-3001
CITY:	COLEVILLE	STATE: CA	ZIP CODE:	96107
CAPACITY:	16	CENSUS: 4	DATE:	05/24/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Kristina Beauont, Teacher		TIME COMPLETED:	01:00 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 5/24/2024, Licensing Program Analyst (LPA) Crystal Ali arrived at the facility to conduct an Annual Random Inspection. LPA was met by Site Supervisor Kristina Beaumont and permitted to enter the facility. LPA toured the facility in accordance with the facility sketch with Site Supervisor. During the inspection, LPA observed 4 children and 2 staff providing care and supervision. Facility operates Monday through Friday from 7:45am to 2:15pm. Staffing Ration and Capacity: Facility consists of one classroom, one office, one kitchen, one children’s bathroom, and one 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. Physical Plant: 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. LPA observed individual storage for children's belongings. The children have access to water via individual water bottles and the water fountain on the playground. 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 Kits (2) at the front door are incompliance. Trash cans with tight-fitted lids were observed.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 05/24/2024

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Napping: Children are provided napping time. Children bring their own napping materials. The facility provides the napping mats and sanitizing them each day. Children take their napping materials home every Friday to wash. They do provide a calming/resting area for children, if needed.
Kitchen: Is equipped kitchen with a refrigerator, freezer, air fryer, toaster, and microwave oven. The facility provides morning and afternoon snack. Allergy lists are posted in the kitchen and in the child file. LPA observed an appropriate amount of food and snacks prepared with gloves. The chemicals are kept separate from the food in locked cabinet inaccessible to children. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. The knives are on top of the refrigerator in a drawer. in the LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Menus are posted at least one week in advance and made available for review by the parents. The facility does not participate in the food program. Daily activity schedules are posted showing meal/snack times, and specific activities. Food allergies are noted and are posted in the kitchen on the refrigerator. There is outside food allowed as children bring their own packed lunches. Lunch boxes have ice packs, those without ice packs will be placed in refrigerator with child name on it.
Fire Extinguisher: Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 4/28/23 at 8am. The fire extinguishers (3A40BC) are reading in green and meets the Fire Marshal Codes and Standards (last serviced 6/22/23). One fire extinguisher is at the front door of classroom.
Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets (1) flushed properly; and sink (1) located outside the bathroom to the left are reachable by the children. The bathroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff. Staff bathroom is clean and has 5 cabinets. All 5 cabinets are attached to the wall with safety latches.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 05/24/2024

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Medication: A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The facility teachers are able to pass out medication. Medication is labeled correctly and stored in its original container. Medication is kept in the classroom in locked cabinet until expiration and sent home with the parent for disposal. There are currently no children on medication. There are currently no children in care with IMS needs. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. Isolation area is towards the back of the classroom near kitchen door where a teacher/aide will remain with the child until the parent comes.
Transportation: School does not provide transportation for the preschool children.
Lead Testing/Drinking Water: The facility has had lead testing completed and copy of report is on file.
Outdoor Activity Space: The outdoor play area was inspected. The children and staff walk to their play area on the basketball court (LPA took photo). They have to walk around the gym and near a shed. The area near the shed has an old fence, wood pieces, tumble weeds, and sandbags. The walking path is cleared of derby. Staff must provide 100% supervision when outside in the playground. Children are provided water via individual drinking bottles or the two water bubblers during outdoor play. There is adequate shaded area for rest. The playground is well-fenced and no bodies of water were observed in the outdoor play area.
Records/Documentation: LPA reviewed with facility representative the LIC 311A, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. One teacher needs Mandated Reporter 4 hour training. All other records are in compliance.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 05/24/2024

NARRATIVE

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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 Health & Safety codes.

A notice of site visit was given and must remain posted for 30 days. A copy of this report and copy of appeal rights were provided to facility representative.

Exit interview conducted and report was reviewed with the Site Supervisor, Kristina Beaumont.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Criminal Record Clearance - Child Care Centers
Facility representative was reminded that all adults 18 and over, including
employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 05/24/2024

NARRATIVE

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Lead Testing – Child Care Centers (CCC)
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives
outlined in PIN 21-21.1-CCP.
Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 05/24/2024

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Incidental Medical Services (IMS) - Child Care Centers
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care
Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
PIN 22-05-CCP
MyChildCarePlan.org – Child Care Centers
Facility representative was informed of the MyChildCarePlan.org website; a
consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.
Subscribe to CCLD important information - Child Care Centers
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 platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/24/2024 12:43 PM - 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Employee does not have the required mandated reporter 4 hour training.
	POC Due Date: 06/06/2024
	Plan of Correction
1 2 3 4	Facility Representative will email or send picture via text message to LPA Ali to provide proof of completion of mandated reporter training for the employee.

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) 202-3318
LICENSING EVALUATOR NAME: Crystal Ali	TELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

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