360904386-10-25-2019-12-CC-AMAA-BHAS3R-20191025133133

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360904386
Report Date: 10/25/2019
Date Signed: 10/25/2019 01:31:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	LAKE ARROWHEAD COOPERATIVE PRESCHOOL		FACILITY NUMBER:	360904386
ADMINISTRATOR:	JODY AUTEN		FACILITY TYPE:	850
ADDRESS:	351 N. STATE HIGHWAY 173		TELEPHONE:	(909) 337-8686
CITY:	LAKE ARROWHEAD	STATE: CA	ZIP CODE:	92352
CAPACITY:	24	CENSUS: 14	DATE:	10/25/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jody Auten		TIME COMPLETED:	01:40 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 Aaron Mabika met with Center Administrator, Jody Auten, today for the purpose of conducting an unannounced Annual/Random inspection for the Pre-School. There are 14 children present upon arrival with 1 teacher and 3 volunteers in 1 classroom. Per licensee, the hours of operation are 09:00 AM -12:00 PM Monday -Friday. LPA verified there is at least 1 staff person present with current CPR and First Aid training (exp. 05/20/2020) Snack/lunch are provided by the parents daily, per Administrator. Food serving areas were toured for safety, cleanliness and proper equipment. (1 freezer 1 refrigerator, sink, stove/oven). Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in a storage room. * Bathrooms were toured and LPA noted all toilets (2), sinks (1) were sanitary and operational. LPA observed soap, paper towel and toilet paper and water tested at a safe temperature. LPA observed a water fountain in the room and in the hallway and cubbies with children's names identified and no napping equipment since this is a part time program. All flooring was found to be clean and safe. Teacher/child ratio observed, care and supervision was discussed, children's records were reviewed, parent board observed and fire drills are current. Fire extinguisher operable. Trash cans/storage containers for solid waste had tight-fitting covers that are kept on, and in good repair. First Aid supplies were inventoried, a review of medication policy, including administering, labeling, and storage. Telephone service, heating, lighting and ventilation were evaluated. *Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness, LPA noted shade provided by trees, wood chips covering the entire play area, climbing equipment anchored to the ground. There are no bodies of water on the premises.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LAKE ARROWHEAD COOPERATIVE PRESCHOOL	FACILITY NUMBER: 360904386
	VISIT DATE: 10/25/2019

NARRATIVE

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*Isolation area is located in the pre-school office along within access to a bathroom.

ADMINISTRATION:
*Director is aware that the Department has full inspection authority as specified in Health and Safety Code 1596.852, 1596.853, and 1596.535.
*There were no excluded individuals present; staff present were fingerprint cleared and associated, LPA and Director reviewed Personnel Report (LIC 500) together during this inspection.
*Center was found to be operating within its specified ratio and capacity with one qualified teacher and a team of volunteer parents whose immunization and records is on file.
*Sign in and Out sheets were inspected.
A sampling of 6 children’s files was reviewed and contained emergency contact information, and one staff file was reviewed and contained qualifications.
LPA discussed the following:
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 child care facility (Center or family child care home) are aware of situations that present the greatest danger to children. These situations include:
· Serious health and safety violations resulting in Type A citations;
· Efforts by the Department to revoke a facility’s license. 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). Failure to meet the posting requirements shall result in an immediate civil penalty. In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.
This facility does not provide Incidental Medical Services – IMS. 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

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: LAKE ARROWHEAD COOPERATIVE PRESCHOOL	FACILITY NUMBER: 360904386
	VISIT DATE: 10/25/2019

NARRATIVE

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Questions about Child Centers and ADA, available at: http://www.ada.gov/childqanda.htm
Licensee is advised to visit www.shotsforschool.org for Immunization information.
Licensee was informed of responsibility to report suspected Child Abuse, 1-800-540-4000.
Licensee is advised for quarterly updates to contact the Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

The following was also discussed with the administrator;
1) The children's files should be arranged in separate folders
2) The Blue Immunization cards should be utilized for records
3) While the adjoining kitchen is not utilized for the preschool but for the church, there is a need to have a smoke detector too inside apart from the ones in the preschool room.
4) The emergency Disaster Evacuation Plan should be posted prominently on the board.
An LIC 855 (Declaration Form) was filled out addressing these concerns was filled out and placed on file

The facility is incompliance. Exit interview conducted with Licensee Jody Auten. A copy of the Appeal Rights (LIC 9058) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.
A Confidential Names list (LIC 811) was provided during this inspection.
Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

LIC809 (FAS) - (06/04)

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