364801923-10-3-2024-12-CC-DMAX-D9PTC6-20241003143612

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364801923
Report Date: 09/24/2024
Date Signed: 10/03/2024 02:36:16 PM

Document Has Been Signed on 10/03/2024 02:36 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SBCSS SIEGRIST STATE PRESCHOOL		FACILITY NUMBER:	364801923
ADMINISTRATOR:	NANCY ALVARADO		FACILITY TYPE:	850
ADDRESS:	15922 WILLOW STREET		TELEPHONE:	(760) 244-6225
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	63	CENSUS: 0	DATE:	09/24/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Site Supervisor, Rosemaire Dunn		TIME COMPLETED:	12:32 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 Site Supervisor, Rosarie Dunn today for the purpose of conducting a case management inspection. This State Preschool is located on the grounds of SIEGRIST Elementary School and currently occupies 1 classroom. Staff are requesting to occupy 1 classroom only (Portable A) and decrease the capacity from 63 to 32. The Preschool is fenced off and separated from the Elementary school children. The facility operates 2 sessions, the AM session operates from 8 - 11 am and the PM session operates from 12 - 3pm. Waiver in file for sharing restroom in main building. Waiver request to be updated to indicate children no longer eat in the school cafeteria and do not share the play yard with Special Needs Children. Furniture and equipment were inspected for age appropriateness and good repair. 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 (city filtered water) with disposable cups. LPA observed smoke and carbon monoxide detectors, and fully charged fire extinguishers in the classroom.

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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

FACILITY NAME: SBCSS SIEGRIST STATE PRESCHOOL	FACILITY NUMBER: 364801923
	VISIT DATE: 09/24/2024

NARRATIVE

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There's 1 bathroom located within the classroom that has 1 toilet and 1 sink. Toilet and sink are functioning properly. LPA observed soap, toilet paper and paper towels readily available. The Staff bathroom is located in the main building and will also be used an isolation bathroom.

Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. Large play equipment and structures are securely anchored. The area was observed to be free of debris. There is an area for shade and rest. There is a water fountain for drinking water. Play area was inspected for hazards and inaccessibility to bodies of water.

Measurements for Portable A:
47.08 X 25.17 = 1,185/35 = 33

*All Licensing reports are available for review on-line and are considered public information per Assembly Bill 2621 which 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.
*Parents sign children in and out via Brightwheel app.

*Fire clearance has been received for a capacity of 32 in Portable A and approved for the age group of 2.5 - 5 yrs.
Notice of site visit was given and must remain posted for 30 days. No deficiencies noted as a result of this case management inspection.

An exit interview was conducted and a copy of the report was reviewed and signed by Site Supervisor, Rosemaire Dunn.

SUPERVISOR'S NAME: Deborah Lowe	TELEPHONE: (916) 661-7243
LICENSING EVALUATOR NAME: Donna Maddox	TELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC809 (FAS) - (06/04)

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