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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805168
Report Date: 06/16/2022
Date Signed: 06/16/2022 11:48:28 AM


Document Has Been Signed on 06/16/2022 11:48 AM - 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:ALPHA TOT HOUSE/ST JOHN OF GOD HEALTH CARE SERVFACILITY NUMBER:
364805168
ADMINISTRATOR:SANTIAGO LOPEZFACILITY TYPE:
830
ADDRESS:13333 PALMDALE RDTELEPHONE:
(760) 241-4917
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:10CENSUS: 1DATE:
06/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Sharlett Willcox Director TIME COMPLETED:
11:56 AM
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Licensing Program Analyst (LPA) Steven Montoya met with Director Sharlett Willcox for the purpose of an Random Annual inspection of the Day Care Center. LPA observed 1 children and 1 teachers present during this inspection. Infant Day Care Center consists of 1 classroms. The facility operates Monday through Friday: 4:00 am to 3:00 am. During this inspection LPA toured the facility, observed equipment/supplies, and reviewed a sample of Staff and children (which is listed on alternative license # 364805167. Current Pediatric CPR and First Aid was observed (Exp. 2/2024).

Furniture and equipment were inspected for age appropriateness and good repair. All rooms observed to be clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies with children's names on them for their belongings in each classroom. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water pitchers and disposable cups. LPA observed a sufficient quantity of mats available for napping children. The bedding is stored separately and sent home with parents for washing on Fridays. Mats are cleaned regularly. Doctor prescribed medications are stored in a lock cabinet. Facility has a surveillance system on the premises. Fire extinguisher, smoke detector and carbon monoxide detector were observed to be operable condition.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2022
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: ALPHA TOT HOUSE/ST JOHN OF GOD HEALTH CARE SERV
FACILITY NUMBER: 364805168
VISIT DATE: 06/16/2022
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Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. LPA observed small and large (anchored) play structures with sand underneath and a grass area for active play. There is also a concrete path for tricycles. The area was observed to be free of debris.

ü Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC624B

ü The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot-line at 1-800-540-4000. Also call the CCL office and follow up with a written Unusual Incident/Injury Report (LIC 624B).

Teacher/child ratios were observed. Fire/earthquake drills are current. Director was reminded to review the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

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/childqanda.htm



No deficiencies cited. Exit interview conducted, inspection report, appeals rights and Notice of sight visit was read, signed and provided to director.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC809 (FAS) - (06/04)
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