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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806901
Report Date: 06/06/2019
Date Signed: 06/06/2019 02:40:07 PM

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:SBCUSD-MUSCOY ELEMENTARY SCHOOLFACILITY NUMBER:
364806901
ADMINISTRATOR:DELIA CASTANEDAFACILITY TYPE:
850
ADDRESS:2119 W. BLAKETELEPHONE:
(909) 880-6649
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:30CENSUS: 24DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Patricia AyalaTIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Maddox met with Lead Teacher, Patricia Ayala today for the purpose of conducting an unannounced Annual/Random inspection. Present today were 24 children and 3 staff persons. This Preschool program is held on the grounds of Muscoy Elementary School and occupies 1 classroom, there are 2 half day sessions. The hours of operation: MONDAY THROUGH FRIDAY 8:15 A.M.- 11:15 A.M. AND 12:15 P.M.TO 3:15 P.M. This preschool closes for the summer months and commences in August (closed effective 6/6/19).

**LPA observed age appropriate furniture, equipment, toys and materials. The classroom were observed to be clean and safe and free of any Health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. Children's belongings are kept in cubbies along the wall as you enter classrooms. Drinking water is available inside the classroom in the form of a water fountain.

**The children's bathrooms are located within the classroom, there are 2 bathrooms with 1 toilet and 1 sink in each. The staff rest-room is located in the classroom as well. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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 4
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: SBCUSD-MUSCOY ELEMENTARY SCHOOL
FACILITY NUMBER: 364806901
VISIT DATE: 06/06/2019
NARRATIVE
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All flooring and carpets were inspected for cleanliness, and in good repair. Children do no nap, center serves snacks only (menus posted).

**Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes rubber matting under climbing structures for cushioning material. Equipment and climbing structures are securely anchored. The area was observed to be free of debris. Outside Drinking water is available in the form of a water fountain. There are no bodies of water observed on the premises. The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area.

**The Parent Board located within the classrooms has contains required licensing forms. Staff are certified in Pediatric CPR and First Aid (exp 8/2020).



*Center utilizes electronic signatures, a hard copy can be printed out by District Office. LPA observed a fully stocked first aid kit; fully charged fire extinguishers; and carbon monoxide detectors. Fire Drill/Earthquake log is posted.

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

§1596.8662 - Mandated Reporter training. Staff take the Mandated reporter training every year through the San Bernardino School District.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: SBCUSD-MUSCOY ELEMENTARY SCHOOL
FACILITY NUMBER: 364806901
VISIT DATE: 06/06/2019
NARRATIVE
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§1596.7995 - Employees or volunteers at day care center; immunization requirements; records; exemptions - Staff are required to have the required immunizations as a condition of employment.

**Staff are fingerprinted through the San Bernardino School District.

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 RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SBCUSD-MUSCOY ELEMENTARY SCHOOL
FACILITY NUMBER: 364806901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/01/2019
Section Cited
CCR
101238.2
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Outdoor Activity Space - (b) The outdoor activity space shall be situated to: (1) Provide a shaded rest area for the children. This requirement was no met as evidenced by a tour of the play yard reveals there is no shaded area for children to rest
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LPA will consult with Director, Latasha Kelly for a resolution.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4