364801923-12-20-2019-12-CC-DMAX-BK2NNQ-20191220093705

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364801923
Report Date: 12/18/2019
Date Signed: 12/20/2019 09:37:20 AM

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:	SBCSS SIEGRIST STATE PRESCHOOL		FACILITY NUMBER:	364801923
ADMINISTRATOR:	DEJESUS, CHEZAREY		FACILITY TYPE:	850
ADDRESS:	15922 WILLOW STREET		TELEPHONE:	(760) 244-6225
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	63	CENSUS: 42	DATE:	12/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rosie Dunn		TIME COMPLETED:	02:45 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) Maddox met with Lead Teacher, Ms. Dunn today for the purpose of conducting an unannounced Annual/Random inspection. This State Preschool occupies 2 classrooms (portable A, Siegrist II & Siegriest I-Portable C ) on the grounds of SIEGRIST Elementary School. The Preschool is fenced off and separated from Elementary school children. The facility operates Siegrist I AM Class 7:45am-10:45am and PM Class 11:45am-2:45pm, Siegrist II AM Class 8:30am-11:30am and PM 12:30pm-3:30pm. Portable A, Siegrist II nhad 22C/3T & Siegriest I-Portable C bhad 20C/4T. LPA observed age appropriate toys, materials, furniture and equipment; Both classrooms were clean and free of any Health of Safety hazards. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies in place for children's belongings. Water cooler with disposable cups are readily available for children. LPA inspected and observed bathrooms inside each classroom (each bathroom contained 1 toilet and 1 sink), Children are escorted to additional bathrooms available in the main building. Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

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: SBCSS SIEGRIST STATE PRESCHOOL	FACILITY NUMBER: 364801923
	VISIT DATE: 12/18/2019

NARRATIVE

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Food is prepared at the main Elementary campus cafeteria and the Teacher will pick up the food and bring to classroom. Menus are posted in each classroom.

Sign in and out sheets were reviewed. LPA observed Licensing and Parent boards to be incompliance including the required posting (menu, daily schedule, community activities). Fire/earthquake drills current. First Aid Kit observed.

Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is not administered. There is a separate area for isolation and care of ill children in the office area.

Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Fire/earthquake drills current. Roster current. There are fire extinguishers, smoke detectors, and carbon monoxide detectors in each classroom. All flooring and carpets were inspected for cleanliness, and in good repair.

Staff file review reveals staff are qualified for their perspective positions. Children's files contain required forms and documents. Additional forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

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: SBCSS SIEGRIST STATE PRESCHOOL	FACILITY NUMBER: 364801923
	VISIT DATE: 12/18/2019

NARRATIVE

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**Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes sand and hard rubber mats under climbing structure; there is sufficient and adequate shade available. Large play equipment and climbing structures are securely anchored (swing set and 1large climbing structures). The area was observed to be free of debris. Outside Drinking water is available in the form of drinking fountain. Sandboxes are raked and inspected daily and kept free of hazardous foreign materials. There are no bodies of water observed on the premises. The entire playground is enclosed to protect children and to keep them in the outdoor activity area.

The following general information was discussed during this inspection:

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Mandated Reporter Training Requirements: §1596.8662 - As of January 1, 2018, child care providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

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: SBCSS SIEGRIST STATE PRESCHOOL	FACILITY NUMBER: 364801923
	VISIT DATE: 12/18/2019

NARRATIVE

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Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

*All Licensing reports are available for review on-line and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code, to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.

Fingerprint clearances and transfers: Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state licensed facility to another using form LIC 9182

There were no violations noted as a result of this inspection, Center is operating in accordance to Title 22 Regulations. Copy of 811 (Confidential Names List) was provided during this inspection. Exit interview conducted and a copy of this report was left at the facility. A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019

LIC809 (FAS) - (06/04)

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