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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805889
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:06:12 PM


Document Has Been Signed on 10/19/2023 12:06 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SBCSS MOJAVE VISTA STATE PRESCHOOLFACILITY NUMBER:
364805889
ADMINISTRATOR:NANCY ALVARADOFACILITY TYPE:
850
ADDRESS:16100 BURWOOD AVENUE ROOM 3TELEPHONE:
(760) 241-4144
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:24CENSUS: 0DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Yasmin Jimenez, Site SupervisorTIME COMPLETED:
12:30 PM
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On October 19, 2023, Licensing Program Analyst (LPA) Annelise Villa met Site Supervisor, Yasmin Jimenez for the One Year Required inspection. A tour of the facility was conducted. Upon arrival LPA observed 1 classrooms with 0 preschool age children present. There were 3 staff on the premises working under the facility’s License. Incidental Medical Services (IMS) were discussed.

Indoor/Children’s Area: Childcare center is clean, safe, sanitary and in good repair. Floors of each classroom 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 (cubbies, individually labelled with name) for his/her clothing, and personal belongings.

Trash cans for solid waste have tight fitting lids and water is provided by the facility. All materials and surfaces are toxic free are inaccessible and there is no fireplace. There are working carbon monoxide detectors, smoke detectors and Fire Extinguishers (2A10BC) each the classroom. There is a working landline telephone (landline) on the premises.

Restrooms: LPA inspected and observed one restroom for children’s use. The bathroom is equipped with 6 toilets and 8 sinks. LPA observed soap, toilet paper and paper towels readily available in both restrooms. Water temperature is appropriate.



Continued LIC 809-C
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCSS MOJAVE VISTA STATE PRESCHOOL
FACILITY NUMBER: 364805889
VISIT DATE: 10/19/2023
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Outdoor: Children use an outdoor playground for exercise and free play. The play equipment was inspected for health, safety, good repair and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, debris, No bodies of water were observed. There are areas for shade and rest. Poured in rubber under the playground structure was observed to be in good repair. Metal gates were locked.

Staff/Personnel Records: Designation of Responsibility observed, immunization's, TB clearance, mandated reporter trainings, Director qualifications, health screening, criminal record statement, and statement acknowledging suspected child abuse were reviewed and maintained current.



Facility Records: Roster, fire/disaster drill log last completed 10/19/2023. CPR/First Aid and mandated reporter training were reviewed and maintained current.

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 394L), emergency disaster plan, earthquake preparedness checklist.

Food Service: Food is prepared and provided through SBCCS and staff do not handle food preparation. No food is stored in the classroom.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First aid supplies (thermometer, bandages, scissors) readily available in the classroom. There is an isolation area for children who become ill while in care located in the library area of the classroom. The facility maintains a comfortable temperature at all times, sign in/out sheets available and completed daily at pick up and drop off. Smoking is prohibited on the premises, and daily inspection for illness is conducted. Firearms/weapons are not allowed or stored on premises. There are no pools or bodies of water on the premises.

Electrical outlets are inaccessible, recalled and or prohibited toys or play equipment were observed on the premises. There are no window cords accessible to children.

Continued on LIC 809-C
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCSS MOJAVE VISTA STATE PRESCHOOL
FACILITY NUMBER: 364805889
VISIT DATE: 10/19/2023
NARRATIVE
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Sign in and out sheets are completed daily at pick up and drop off times. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Roster current. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Health Related Services: Director is advised all prescription and non-prescription medications must have child’s name and are dated, written consent and instruction from child’s representative, and a plan to document and report to child’s representative when medication is administered to a child; IMS plan was discussed and Director understands when IMS is necessary.

Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered only with parent's written permission (licensing medication form- LIC9221 - also used). Per Director, she does not have children enrolled who require medication. LPA advised the Director must administer medication, and document the dosage, date and time onto a log. Medication can be brought and taken home by the parent daily. Medication will be properly labeled and stored in its original container. There is a separate area for isolation and care of ill children in the director’s office.

Currently, Incidental Medical Services are not provided to children in care. LPA reviewed 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.html

Director 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 the day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Continued on LIC 809-C
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCSS MOJAVE VISTA STATE PRESCHOOL
FACILITY NUMBER: 364805889
VISIT DATE: 10/19/2023
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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 childcare center, 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 was cited today.

Exit interview conducted and report was reviewed with the Director. This report was read and provided to along with her appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Annelise VillaTELEPHONE: 661-202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4