360910831-3-6-2020-12-CC-SMOA-BMFSUT-20200306131139

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360910831
Report Date: 03/06/2020
Date Signed: 03/06/2020 01:11:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	PSD/APPLE VALLEY HEAD START		FACILITY NUMBER:	360910831
ADMINISTRATOR:	DOLORES EDWARDS		FACILITY TYPE:	850
ADDRESS:	13589 NAVAJO ROAD		TELEPHONE:	(760) 247-6955
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	117	CENSUS:	DATE:	03/06/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:24 AM
MET WITH:	Dee Edwards Site Supervisor		TIME COMPLETED:	01:21 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 Analysts (LPA) Montoya met with Site Supervisor Dee Edwardsr, today for the purpose of conducting an unannounced Annual/Random inspection for the Pre-School. There are 11 children present upon arrival with 2 teacher and 1 classrooms. Per site supervisor the hours of operation are 7:00 am - 5:00 pm Monday - Friday. The Center also has an Pre school component. This facility does provide Incidental Medical Services (IMS). LPA verified there is at least 1 staff person present with current CPR and First Aid training (exp. 12-20-20) Snack/lunch menus, Allergy list 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 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 storage locked cabinet. * LPA observed 6 Classrooms, Bathrooms (9) noted all toilets (9), sinks (7) were sanitary and operational. LPAs observed soap, paper towel and toilet paper and water tested at a safe temperature. Each classroom has a bottle water, disposable cups, cubbies with children's names identified and cots.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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

FACILITY NAME: PSD/APPLE VALLEY HEAD START	FACILITY NUMBER: 360910831
	VISIT DATE: 03/06/2020

NARRATIVE

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*All flooring was found to be clean and safe. Site Supervisor states carpets are cleaned every 3 month.
**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, LPAs noted shade, and drinking water: There are no bodies of water on the premises.

*Isolation area is located in the front classrooms along with no isolation bathroom.

ADMINISTRATION:
*Site Supervisor 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, LPAs and Site Supervisor 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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

FACILITY NAME: PSD/APPLE VALLEY HEAD START	FACILITY NUMBER: 360910831
	VISIT DATE: 03/06/2020

NARRATIVE

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*Center was found to be operating within its specified ratio and capacity.

*Sign in and Out sheets were inspected.

Reviewed and contained emergency contact information, staff files were 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;
· 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. 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.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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

FACILITY NAME: PSD/APPLE VALLEY HEAD START	FACILITY NUMBER: 360910831
	VISIT DATE: 03/06/2020

NARRATIVE

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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 Centers and ADA, available at: http://www.ada.gov/childqanda.htm

***Center has Physical separation for each component (101438.3)

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”.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

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

FACILITY NAME: PSD/APPLE VALLEY HEAD START	FACILITY NUMBER: 360910831
	VISIT DATE: 03/06/2020

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 26 27 28 29 30 31 32	this report must be posted for 30 days in visible location the authorized representatives of children. The following deficiencies are being cited in accordance to Title 5 of the California Code of Regulations and/or Health & Safety codes. Exit Inspection;

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PSD/APPLE VALLEY HEAD START	FACILITY NUMBER: 360910831
	VISIT DATE: 03/06/2020

NARRATIVE

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Exit interview conducted with Site Supervisor Dee Edwards.. 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.

There are no deficiencies are being cited in accordance to Title 5 of the California Code of Regulations and/or Health & Safety codes.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2020

LIC809 (FAS) - (06/04)

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