360908938-10-28-2019-12-CC-AMAA-BHE22K-20191028170052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360908938
Report Date: 10/28/2019
Date Signed: 10/28/2019 05:01:03 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:	MT. CALVARY LUTHERAN PRESCHOOL		FACILITY NUMBER:	360908938
ADMINISTRATOR:	RITA MANCINI		FACILITY TYPE:	850
ADDRESS:	27415 SCHOOL ROAD		TELEPHONE:	(909) 337-7750
CITY:	CREST PARK	STATE: CA	ZIP CODE:	92326
CAPACITY:	84	CENSUS: 19	DATE:	10/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:48 PM
MET WITH:	Rita Mancini		TIME COMPLETED:	05:15 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 Director Rita Mancini, today for the purpose of conducting an unannounced Annual/Random inspection for the Pre-School. There are 19 children present upon arrival with 4 teacher and 4 classrooms. Per Director the hours of operation are 08:00 AM -06:00 PM Monday -Friday. The Center also has a School-Age component. LPA verified that all staff persons present have current CPR and First Aid training (exp. August 6 2021) Snack are provided and lunch are brought in by parents. The snack menus were observed. Allergy lists were reviewed and posted. Food and snacks were reviewed for availability, quantity, proper storage, and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. (1 refrigerator, sink and micro wave oven and a wwater fountain in every room). Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in kitchen locked cabinet. * The 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. Each classroom was observed to be have cubbies with children's names identified, and adequate napping equipment and an Emergency kit. LPA observed a changing station in every room. All flooring was found to be clean and safe (Director states carpets are cleaned every day. 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 and has a service date of May 2019. LPA observed a combination smoke/carbon monoxide detector, central fire alarm system and emergency ceiling based water sprinkler systems in every room. 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

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: MT. CALVARY LUTHERAN PRESCHOOL	FACILITY NUMBER: 360908938
	VISIT DATE: 10/28/2019

NARRATIVE

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*Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness, LPA noted shade provided by trees climbing equipment, a sand pit, jungle gym and a storage shed with tricycles and other toys that is shared with the other component. There are no bodies of water on the premises.
*Isolation area is located in the front office along with the isolation 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.
A review of medication policy indicated that prescription medication is administered only with parent's written permission. The Director administers medication and documents the dosage, date and time onto a log. Medication brought and taken home by the parent daily. Medication is properly labeled and stored in its original container.
*Center was found to be operating within its specified ratio and capacity.
*Sign in and Out sheets were inspected.
A sampling of 5 children’s files was reviewed and contained emergency contact information. Four staff files were reviewed and contained the necessary 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;
· Non-compliance conferences; or
· 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron Mabika	TELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

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: MT. CALVARY LUTHERAN PRESCHOOL	FACILITY NUMBER: 360908938
	VISIT DATE: 10/28/2019

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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. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s personnel, and administrative records. 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 Questions about Child Centers and ADA, available at: http://www.ada.gov/childqanda.htm

***Center has Physical separation for each component (101438.3) The director was made to complete a Declaration about separation of components at the play center and it will be kept on file.

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”.

This Center is in compliance and operating in according to California Code of Regulations Title 22 so no deficiencies were cited. Exit interview conducted with Licensee Rita Mancini. 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 857) 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: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

LIC809 (FAS) - (06/04)

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