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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364812085
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:24:39 PM


Document Has Been Signed on 09/27/2022 12:24 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:SJUSD-PINON HILLS ELEMENTARY SCH. STATE PRESCHOOLFACILITY NUMBER:
364812085
ADMINISTRATOR:KIMBERLY MARTINFACILITY TYPE:
850
ADDRESS:878 MONO ROADTELEPHONE:
(760) 792-8097
CITY:PINON HILLSSTATE: CAZIP CODE:
92372
CAPACITY:24CENSUS: 20DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Gabriela MartinezTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Ibitoye met with Child Care Facility (CCF) Lead Teacher Gabriela Martinez, today for the purpose of conducting a Required 1 year unannounced Annual inspection for the child care facility. CCF has a Pre school-age component. There were 20 children present, with 2 teachers providing care. LPA verified there is at least 1 staff person present with current CPR and First Aid training (exp. 09-10-24)
Hours of operation are: Monday thru Friday (between 8:15 AM – 11:15 AM).

During the time of the inspection, LPA observed and reviewed records to verified accuracy:

1. Sampling of children's records (4) (See LIC 857)


2. Sign In and Out sheets were inspected.
3. Emergency contact information observed
4. Parent board observed
5. Staff personnel files (2) reviewed for educational & certification. (See LIC 859 )
6. Pediatric CPR and First Aid training for Lead staff (EXPIRES: 09/10/24)
7. Mandated Reporter Training (EXPIRES: 08-24-2023);
8. Emergency Earthquake and Fire Drills log were current and up to date
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: SJUSD-PINON HILLS ELEMENTARY SCH. STATE PRESCHOOL
FACILITY NUMBER: 364812085
VISIT DATE: 09/27/2022
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*Snack/lunch menus, 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 .

*Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in storage locked cabinet.

* LPA observed 1 Classrooms, (1) Bathrooms, (3) Sinks noted, all toilets were sanitary and operational. LPAs observed soap, paper towel and toilet paper and water tested at a safe temperature. the classroom has a bottle water, disposable cups, cubbies with children's names identified and cots.

*All flooring was found to be clean and safe.

**Teacher/child ratio observed, care and supervision were discussed, children's records were reviewed, parent board observed, and fire drills are current. Fire extinguisher operable.

*Trash cans/storage containers for solid waste had tight-fitting covers that are kept on, and in good repair.

*First Aid supplies were inventoried, a review of medication policy, including administering, labeling, and storage. *Telephone service, heating, lighting, and ventilation were evaluated.

*Outdoor area and equipment were inspected for safety, wood chips material, good repair and age appropriateness, LPAs noted shade, and drinking water: There are no bodies of water on the premises. *Isolation area is in the front Office.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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: SJUSD-PINON HILLS ELEMENTARY SCH. STATE PRESCHOOL
FACILITY NUMBER: 364812085
VISIT DATE: 09/27/2022
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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”.

On January 1,2018 or before March 30,2018, a person who, is a licensed childcare provider, administrator, or employee of a licensed child day care facility shall complete the on-line mandated reporter training and shall complete renewal mandated reporter training every two years. www.mandatereporterca.com

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

ADMINISTRATION:

*Lead Teacher t is aware that the Department has full inspection authority as specified in Health and Safety Code 1596.852, 1596.853, and 1596.535.

*There were no excluded individuals present; staff present were fingerprint cleared and associated.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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: SJUSD-PINON HILLS ELEMENTARY SCH. STATE PRESCHOOL
FACILITY NUMBER: 364812085
VISIT DATE: 09/27/2022
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A review of medication policy indicated that prescription medication is administered only with parent's written permission. The school nurse administers medication and documents the dosage, date, and time onto a log. Medication brought and taken home by the parent daily. Medication is properly labeled and stored in its original container.

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

Center was found to be operating within its specified ratio and capacity.

Children file were reviewed and contained emergency contact information, staff files were reviewed and contained qualifications.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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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: SJUSD-PINON HILLS ELEMENTARY SCH. STATE PRESCHOOL
FACILITY NUMBER: 364812085
VISIT DATE: 09/27/2022
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There were no citations issued because of this inspection, Center is operating in compliance with Title 22 Regulations.

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.

Exit interview conducted with Lead Teacher Gabriela Martinez. A copy of the Appeal Rights (LIC 9058) was given and explained. Lead Teacher signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
LIC809 (FAS) - (06/04)
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