360908938-10-7-2024-12-CC-KZIS-D9TQKF-20241007121415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360908938
Report Date: 10/07/2024
Date Signed: 10/07/2024 12:14:27 PM

Document Has Been Signed on 10/07/2024 12:14 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:	KIMBERLY KOPECKY		FACILITY TYPE:	850
ADDRESS:	27415 SCHOOL ROAD		TELEPHONE:	9093377750
CITY:	CREST PARK	STATE: CA	ZIP CODE:	92326
CAPACITY:	84	CENSUS: 27	DATE:	10/07/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Facility Representative Kelly Welch and Administrator Kimberly Kopecky		TIME COMPLETED:	12:20 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 (LPA) Zirbes met with Facility Representative Kelly Welch for the purpose of conducting an unannounced required Annual/Random inspection for the Preschool Center. After LPAs arrival the Administrator Kimberly Kopecky arrived on site to assist LPA with the annual inspection. During the inspection, LPA observed 27 preschool/toddler age children on site with five teachers and the Administrator. Based on LPA observation the Center was meeting the ratio and capacity regulations during this inspection. The preschool age component is operated out of four classrooms (1, 2, 3, and 5). Classroom 1 is designated for the toddlers. The Center is also licensed to provide care to school age children (license number: 364841130). The Center has a kitchen, staff restrooms, staff office and outdoor activity space which are utilized by both components. The facility currently operates Monday through Friday 8:00am -5:00pm. The Center follows the Rim of the World School District calendar. The Center has an approved waiver regarding the outdoor activity space and commingling during the first and last hour. Indoor/Children's Area: Child care center was observed to be clean, 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 classroom and in a locked closet in classroom 5. In each classroom the cleaning supplies were stored in high inaccessible cabinets or in cabinets equipped with child safety latches. LPA observed the indoor furniture/equipment was in good condition. Classrooms were free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the Center had a variety of art supplies, blocks, books, dramatic play. 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 children's water bottles. All materials and surfaces are toxic free, window screens in good repair and free of debris. LPA observed carbon monoxide detectors throughout the licensed space. 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: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

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

FACILITY NAME: MT. CALVARY LUTHERAN PRESCHOOL	FACILITY NUMBER: 360908938
	VISIT DATE: 10/07/2024

NARRATIVE

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Report continued from page one
Restrooms: The Center has a total of five restrooms. Four are designated for the preschool program and one is designated for the staff. Classroom 1 has one toilet, two sinks and a diaper changing area. Classroom 2 has two toilets, two sinks and a diaper changing area. Classroom 5 has access to one restrooms with three toilets and three sinks. Classroom 3 has two toilets and two sinks. Toilets and sinks were functioning properly, sanitary and are age appropriate. Paper towels and soap were available to the children.
Meals: The families of the enrolled children provide two snacks, and a lunch for their child.
Napping: Mats are utilized for napping.

Outdoor: LPA inspected the outdoor play space for health, safety, cushioning material, good repair and age appropriateness. The space contained two climbing structures and additional outdoor play materials were available in a locked storage container. The climbing structures were placed on wood chips and were anchored to the ground. The outdoor areas were clean and free of hazards at this time. Water is accessible to the children via a individual water bottles.

Child/Personnel Records
LPA reviewed five child records and five personnel files during this inspection. Child and Personnel records were complete and contained all required information.

Facility Records

LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.

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.
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: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

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: 10/07/2024

NARRATIVE

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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.

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.

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 PIN 22-02-CCP. 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-carecenters/.

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.

Report continued page four

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

LIC809 (FAS) - (06/04)

Page: 3 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: 10/07/2024

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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.

As a result of this inspection, zero advisory notices or citations were issued.

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 Kim Kopecky.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024

LIC809 (FAS) - (06/04)

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