360911461-12-7-2021-12-CC-LTMR-C9GSUB-20211207131053

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360911461
Report Date: 12/07/2021
Date Signed: 12/07/2021 01:10:59 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:	ZION LUTHERAN PRESCHOOL		FACILITY NUMBER:	360911461
ADMINISTRATOR:	M'LESS TRIPPLE		FACILITY TYPE:	850
ADDRESS:	15342 JERALDO DRIVE		TELEPHONE:	(760) 243-3074
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92394
CAPACITY:	124	CENSUS: 15	DATE:	12/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	M'Less Tripple		TIME COMPLETED:	01:26 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) Thompson-Miller met with the facility Director, M'Less Tripple and conducted a Required One Year inspection. LPA toured and inspected the preschool in accordance with the facility sketch. LPA observed 15 children upon arrival. There were 3 teachers on the premises and the director. The facility consists of 4 classrooms (yellow, green, red, blue). The yellow and green rooms are currently not being used (low enrollment). There are also 2 additional classrooms located on the elementary school site currently not used (low enrollment). The facility operates from 6:00am to 6:00pm. Monday through Friday. Incidental Medical Services (IMS) policy was discussed. Indoor/Children's Area: The center is clean, safe, sanitary and in good repair, there are no potential hazardous areas observed (passageways), floors are clean and safe, cleaning compounds are inaccessible, poisons locked, furniture and equipment in good condition, no insects or flies observed, play equipment are age appropriate. Each child has own cubby, trash cans have tight fitting lids, drinking water is available, no toxic materials observed, no fireplace, window screens in good repair. LPA observed the carbon monoxide, Fire Extinguisher and smoke detector in working condition. Age appropriate toilets and sinks in working condition. There is a working telephone on the premises, isolation area for ill children at the office area, room temperature is comfortable, First Aid Kit observed, sign in/out observed, COVID-19 protocol observed (temperature check), no smoking on the premises. There are no prohibited play equipment on the premises. Furniture and equipment were inspected for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water pitcher-Igloo, disposable cups. LPA observed a sufficient quantity of cots available for napping children. The bedding is stored (zip lock washable bag) separately (cubby) and properly. Per Director the sheets are washed (weekly or as needed) and cots are sanitized daily.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: ZION LUTHERAN PRESCHOOL	FACILITY NUMBER: 360911461
	VISIT DATE: 12/07/2021

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

Napping: LPA observed cots in safe condition, sanitize after each use, cots spaced to have access to a safe walkway, bedding is not in contact with other bedding.

Restrooms: Toilets and sink are safe and sanitary, no hot water in restroom, paper towels observed for children use.

Outdoor: Center has a shaded area, play ground free from hazards and debris, play structure has cushioning material (sand), sandbox inspected daily, air condition unit inaccessible.

Health Related Services: Medications when used are inaccessible to children (locked in classroom), child name and date on medication, parent written consent as required.

Food Service: Food prepared and served in a safe manner, food preparation is completed in the kitchen (warming kitchen - no stove/oven), cleaning compounds are kept in the supply room (off limits), silverware are cleaned and sanitized after each use, refrigerator temperature in regulation, menu posted in kitchen and classroom, breakfast and snack provided, children bring own lunch.

Staff Records: LPA reviewed files for Director Qualifications, immunization, licensing forms (LIC9108, Mandated Reporter, LIC508, LIC308).

Facility Records: LPA observed the Roster to be complete and current, staff has current CPR/First Aid expire 12/02/2022, fire and earthquake drills are conducted monthly.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: ZION LUTHERAN PRESCHOOL	FACILITY NUMBER: 360911461
	VISIT DATE: 12/07/2021

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

Posting Requirements: Center has required posting (license, PUB 393L, car seat law, emergency disaster plan, earthquake preparedness, lead poison).

Documents Discussed: IMS (Incidental Medical Services).

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.

Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days. The report was read with Director. Exit interview conducted and report was reviewed with Director, M'Less Tripple on this date.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3