364803507-5-4-2022-12-CC-LTMR-CE4TF7-20220504144103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364803507
Report Date: 05/04/2022
Date Signed: 05/04/2022 02:41:12 PM

Document Has Been Signed on 05/04/2022 02:41 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SBCSS LEMON STREET STATE PRESCHOOL		FACILITY NUMBER:	364803507
ADMINISTRATOR:	CHEZAREY DE JESUS		FACILITY TYPE:	850
ADDRESS:	16633 LEMON STREET		TELEPHONE:	(760) 956-3537
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	30	CENSUS: 11	DATE:	05/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:47 AM
MET WITH:	Marina Alcaraz, Assoc Teacher/Site Supervisor		TIME COMPLETED:	03:00 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 Marina Alcaraz, Associate Teacher/Site Supervisor and conducted an Annual Random inspection. LPA toured and inspected the preschool in accordance with the facility sketch. Upon arrival staff preparing for the afternoon session. LPA observed 11 children for the afternoon session with one teacher and one Aide along with the Ms. Alcaraz. The facility consists of 1 classroom (divided into two sections). The facility operates a morning and afternoon program (AM Session 8:00am to 11:00am, PM Session Noon to 3:00pm) Monday through Friday. The center follows Hesperia School District schedule. Incidental Medical Services (IMS) policy was discussed. Indoor/Children’s Area: Furniture and equipment were inspected for age appropriateness and good repair. Rooms are is clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings in classroom. LPA observed age appropriate toys and materials. Drinking water is available inside the classroom in the form water fountain and Dixie cups. Children do not nap. Child care center is clean, safe, 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 inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings. Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors (Dixie cups). All materials and surfaces are toxic free are inaccessible, no fireplace. There is a working Carbon monoxide detector, smoke detector and Fire Extinguisher (2A10BC).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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 5

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: SBCSS LEMON STREET STATE PRESCHOOL	FACILITY NUMBER: 364803507
	VISIT DATE: 05/04/2022

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

There is an isolation area for children who become ill while in care located in the library area, facility maintains a comfortable temperature at all times, first aid supplies (thermometer, bandages, scissors). Sign in/out sheets available and completed daily. No Smoking on the premises, daily inspection for illness, no prohibited child care items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.

Napping: Children do no nap.

Restrooms: LPA inspected and observed 1 clean bathroom (3 toilets, 3 sinks, there is a sink inside both classrooms (water fountain with sink). Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available. Water temperature is appropriate. Toilet/sink safe and sanitary, if hot water (temperature 105 degrees F and 120 degrees F), hand washing fixture used by children are not required to deliver hot water. One toilet and one sink available for ill children, staff and emergency. Common towels or washcloths are prohibited.

Child care center is clean, safe, 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 inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings. Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors (Dixie cups). All materials and surfaces are toxic free are inaccessible, no fireplace. There is a working Carbon monoxide detector, smoke detector and Fire Extinguisher (2A10BC).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: SBCSS LEMON STREET STATE PRESCHOOL	FACILITY NUMBER: 364803507
	VISIT DATE: 05/04/2022

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

Outdoor: Outdoor play equipment was inspected for health, safety, cushioning material (wood chips, grass), 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. The play yard is divided into two sections (gated). One section has the Little Tikes play equipment, there are 4 sheds (key lock), table, chairs, outside toys. Drinking water is available in the form two water fountains (one on each section of the play yard). Play area was inspected for hazards and inaccessibility to bodies of water. No body of water observed.

Facility has a shaded rest area; large climbing structure with cushion, free from hazard, holes, broken items, debris, dry grass; cushioning material underneath (wood chips), sandboxes free of hazardous items; six feet fence surrounding outdoor area, air conditioning equipment, water heaters, fuse boxes inaccessible.

Health Related Services: Children are inspected for illnesses as they arrive. A review of medication policy indicated that prescription medication is administered only with parent's written permission and doctor form. The Teacher administers medication and documents the dosage, date and time onto a log. Medication is properly labeled and stored in its original container. Medication as necessary are sent home daily. There is a separate area for isolation and care of ill children in the library area. There is a cot available for each ill child.

Snacks are served in the morning and afternoon session provided by a private contractor. There is a kitchen (key lock) which has a stove, refrigerator and microwave oven, allergy list posted (names for AM class/PM class name posted) and chemicals are kept in a locked cabinet. The chemicals are kept separate from the food. The AM and PM programs are served the same snack. Menus are posted on the parent information board. Allergy lists observed and posted. Trash can with tight fitting lids.

Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Staff were questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations. Personal rights of children were discussed.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: SBCSS LEMON STREET STATE PRESCHOOL	FACILITY NUMBER: 364803507
	VISIT DATE: 05/04/2022

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 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 Care Centers and the ADA, available at: http://www.ada.gov/childquanda.htm

Food Service/Kitchen: The kitchen area is a separate area on the premises located next to the restrooms for staff and children. The kitchen cleaning items and sharp knives are kept in a locked cabinet. Facility food is safe, stored, prepared and served in a safe manner; food preparation and storage areas are clean; dishes and utensils are clean and sanitized-dishwasher; menu posted one week or more in advance; snack shall include at least one serving from 2 or more of the 4 food groups. Facility serves snack and no lunch. Food preparation area is not being used for play activities or napping; food and beverages stored in covered containers at 45 degrees or less, no food damaged containers were observed.

Staff/Personnel Records: Director is qualified, Designation of Responsibility, immunization's, TB clearance, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.
Facility Records: Roster, disaster drill log and CPR/First Aid expire 05/2023 and mandated report (current) were reviewed.
Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted (menus, daily schedule, community activities, lesson plan newsletter). Fire/earthquake drills current.

Children's records and staff records were reviewed. Staff are certified in Pediatric CPR and First Aid. LPA observed staff interaction with students (outside play time, free time inside).

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-Miller	TELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: SBCSS LEMON STREET STATE PRESCHOOL	FACILITY NUMBER: 364803507
	VISIT DATE: 05/04/2022

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: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393L), menu, car seat law (PUB 269), emergency disaster plan, earthquake preparedness checklist.
Documents Provided and or Discussed: COVID-19 flyers, Lead Flyer Requirement, forms and records to keep at the facility and IMS.
Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. Electrical outlets are inaccessible, no recalled and or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children.

Staff advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.

Staff 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
No deficiency. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.
Exit interview conducted and report was reviewed with Marina Alcaraz, Associate Teacher/Site Supervisor. This report was read and provided to Marina Alcaraz, Associate Teacher/Site Supervisor 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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5