364808716-12-19-2019-12-CC-SMOA-BJZREV-20191219115811

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808716
Report Date: 12/19/2019
Date Signed: 12/19/2019 11:58:26 AM

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:	AVUSD SANDIA STATE PRESCHOOL		FACILITY NUMBER:	364808716
ADMINISTRATOR:	PETE RODINE, ED.D.		FACILITY TYPE:	850
ADDRESS:	21331 SANDIA		TELEPHONE:	(760) 240-3155
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	48	CENSUS: 17	DATE:	12/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Leandra Figueroa Lead Teacher		TIME COMPLETED:	12:05 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) Montoya made an unannounced visit at the Sandia Pre School and met with Site Supervisor Leandra Figueroa Lead Teacher for the purpose of conducting an Annual/Random inspection. Present during time of inspection were 17 children, with 6 staff providing care in two classrooms. LPA reviewed records and toured 2 classrooms in the center, inside and out. During the time of the inspection, LPA observed and reviewed records to verified accuracy: 1. Sampling of children's records (See LIC 857) 2. Sign In and Out sheets were inspected. 3. Emergency contact information observed 4. Parent board observed: Accurate and up to date. 5. Staff personnel files reviewed for educational and certification. (See LIC 859 & LIC 500) 6. Pediatric CPR and First Aid training for one staff (EXPIRES: 10-2021) 7. Mandated Reporter Training (EXPIRES: 11-12-2020) 8. Emergency Fire Drills were current and up to date.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AVUSD SANDIA STATE PRESCHOOL	FACILITY NUMBER: 364808716
	VISIT DATE: 12/19/2019

NARRATIVE

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INDOOR INSPECTION:
During today’s inspection, LPA toured the location. Observed teacher/child ratio, care and supervision. **Fire Extinguisher up to date and operable. (EXPIRES: 12-02-2020)
Bathrooms (2) were inspected and LPAs noted all toilets (2), sinks (2) were sanitary and operational. LPAs observed soap, paper towel and toilet paper. Each classroom has a water fountain, cubbies with children's names identified and cots. All flooring was found to be clean and safe.
**(Lead Teacher states carpets are cleaned every 6 month. Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in kitchen locked cabinet. Trash cans/storage containers for solid waste were covered with tight-fitting tops that are kept on, and in good repair. *Snack/lunch menu’s, Allergy list were reviewed and posted. Food and snacks were reviewed for availability, quantity, proper storage, and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. (1 refrigerator, 2 sink). Location had telephone service, heating/cooling, lighting and ventilation were evaluated. *First Aid supplies were discussed and inspected along with medication policy, including labeling, administering and appropriate storage in original container.

A review of medication policy indicated prescription medications are administered with “parent's written permission”. Certified staff administers medications and documents: date, time and dosage onto a log. Medication brought and taken home by the parent daily.
*Incidental Medical Services (IMS) were discussed and location do not provide services.
*Children who are sick have an isolation area is located in the front classroom.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AVUSD SANDIA STATE PRESCHOOL	FACILITY NUMBER: 364808716
	VISIT DATE: 12/19/2019

NARRATIVE

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OUTDOOR INSPECTION
*Outdoor area and equipment inspected for safety, cushioning material, good repair and age appropriateness, LPAs noted shade, and drinking water: No pool or bodies of water observed on the premises.

ADMINISTRATION:
Staff is aware the Department has “full inspection authority” per Health and Safety Code 1596.852, 1596.853, and 1596.535. *There were no excluded individuals present;
**All staff present received fingerprint cleared and associated,
LPA discussed the following:
Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility (Center or family child care home) are aware of situations that present the greatest danger to children. These situations include:
· Serious health and safety violations resulting in Type A citations;
· Non-compliance conferences; or
· Efforts by the Department to revoke a facility’s license. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Failure to meet the posting requirements shall result in an immediate civil penalty. In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AVUSD SANDIA STATE PRESCHOOL	FACILITY NUMBER: 364808716
	VISIT DATE: 12/19/2019

NARRATIVE

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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 Centers and ADA, available at: http://www.ada.gov/childqanda.htm

***Center has Physical separation for each component (101438.3)

Licensee is advised to visit www.shotsforschool.org for Immunization information.
Licensee was informed of responsibility to report suspected Child Abuse, 1-800-540-4000.
Licensee is advised for quarterly updates to contact the Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AVUSD SANDIA STATE PRESCHOOL	FACILITY NUMBER: 364808716
	VISIT DATE: 12/19/2019

NARRATIVE

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The following deficiencies are being cited in accordance to Title 5 of the California Code of Regulations and/or Health & Safety codes: NONE .

Exit interview conducted with Site Supervisor The following deficiencies are being cited in accordance to Title 5 of the California Code of Regulations and/or Health & Safety codes. Licensee’s signature on this form acknowledges receipt of these rights.

Notice of Site Visit has been posted (LIC9213) The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.

SUPERVISOR'S NAME: Claretta Yates	TELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

LIC809 (FAS) - (06/04)

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