360908938-4-14-2023-12-CC-KZIS-CQVUU3-20230414155253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360908938
Report Date: 04/14/2023
Date Signed: 04/14/2023 03:53:15 PM

Document Has Been Signed on 04/14/2023 03:53 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:	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: 28	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Facility Representative, Macyn Kopecky		TIME COMPLETED:	04:00 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 April 14, 2023 at 1:28 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Annual Required Inspection. and met with Facility Representative Macyn Kopecky. LPA disclosed the purpose of the inspection and was granted entry into the facility by Facility Representative. 28 children and six (6) staff members were present at the facility during the inspection. The facility is located on the grounds of Mt. Calvary Lutheran Church. Center occupies a two story building, where the preschool program and a school age program are operated out of. The preschool program operates out of three (3) classrooms (Little's, Middles, and Bigs). The preschool center has three (3) bathrooms, a staff office and a outdoor play space. The hours of operation: 8:00am to 5:00pm Monday to Friday. The Center follows the Rim of the World School District calendar. At approximately 1:45 p.m. LPA and facility representative completed a tour of the preschool center, to included the indoor and outdoor area. Indoor/Children's Area: Child care center was observed to be clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean. Cleaning compounds were stored in each class room in cabinets equipped with child safety lock or on high shelf's that are inaccessible to the children. LPA observed the furniture/equipment is in good condition. Classrooms were free of flies, other insects, rodents. The classrooms had tables and chairs and various equipment to meet children’s needs. LPA observed each classroom had books, blocks, art supplies, and additional equipment that met the child's age and development. Children's belongings are kept in cubbies labeled with the children's names. Trash cans for solid waste have tight fitting lids. Drinking water is readily available indoors via water bottles provided by the parents/authorized representatives. The water bottles are filled utilizing water from a lead tested faucet. All materials and surfaces are toxic free, window screens in good repair and free of debris. There is a working carbon monoxide detector, smoke detector and Fire Extinguishers which were serviced in 2022. There is one bathroom located in each classroom. Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available. Report continued on page two

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: MT. CALVARY LUTHERAN PRESCHOOL	FACILITY NUMBER: 360908938
	VISIT DATE: 04/14/2023

NARRATIVE

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Report continued from page one

There was working telephone service within the facility. There is an isolation area for children who become ill. The facility maintains a comfortable temperature at all times. LPA observed the centers sign in/out sheets, which are completed daily. Smoking is prohibited on the premises. Teacher conducts daily inspection for illnesses. LPA did not observe prohibited childcare items during this inspection. Firearms/weapons are not allowed or stored on premises. LPA did not observe bodies of water on the premises.

Napping
LPA observed the children sleeping on mats. The mats were in good condition.

Outdoor
LPA observed the outside play space. During this inspection, LPA observed the roof above the outdoor climbing structure, the slide, and the sand box sustained damage during the recent winter storm. Per conversation with the facility representative children are not utilizing the climbing structure or sand box at this time due to the damage. The children are utilizing the hard top area with bikes and balls and other large motor activities. LPA observed the climbing structure is place on recycled rubber mulch. Per conversation with facility representative the play space is fully enclosed with a fence. LPA observed the fence may also have sustained damage due to the winter storm. LPA advised the Center to submit a unusual Incident Report (UIR) and report the damage to the Department. In addition, LPA advised the Center to install a barrier which prevents the children from accessing the climbing structures until repairs can be made.
Health Related Services
This facility provides 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 Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Report continued on page three

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: MT. CALVARY LUTHERAN PRESCHOOL	FACILITY NUMBER: 360908938
	VISIT DATE: 04/14/2023

NARRATIVE

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Facility Records
LPA observed a current roster, and observed the disaster drill log (conducted March 2023).

LPA and Facility representative discussed the required Lead Testing requirements. Per Facility Representative the lead testing was completed in 2023.

Posting Requirements
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), car seat law (PUB 269), emergency disaster plan, earthquake preparedness checklist. LPA reminded the center representative that failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Other: Electrical outlets are inaccessible, there are no recalled and or prohibited toys or sleep/play equipment observed on the premises. Window cords were inaccessible to children.

LPA was unable to review the staff and child files during this inspection. Therefore LPA will return on a future date to review the files.

One advisory notice was provided to the facility based on LPA observation.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Macyn Kopecky

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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