364813457-4-27-2023-12-CC-KZIS-CRATHV-20230427144523

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813457
Report Date: 04/27/2023
Date Signed: 04/27/2023 02:45:42 PM

Document Has Been Signed on 04/27/2023 02:45 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:	PSD-CRESTLINE HEAD START		FACILITY NUMBER:	364813457
ADMINISTRATOR:	DENISE GRECIAN		FACILITY TYPE:	850
ADDRESS:	22836 FIR LANE		TELEPHONE:	(909) 338-1470
CITY:	CRESTLINE	STATE: CA	ZIP CODE:	92325
CAPACITY:	30	CENSUS: 24	DATE:	04/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Facility Representative Natalia Mundo-Romo		TIME COMPLETED:	03:00 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	On April 27, 2023 at 09:45 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Annual Required Inspection and met with Facility Representative Natalia Mundo-Romo. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Facility Representative. 24 children, six (6) staff members were present at the facility during the inspection. The preschool program consists of two classrooms, two children's restrooms, one staff bathrooms, main office and an outdoor space. The programs hours of operation are Monday thru Friday 7:30 - 4:30 p.m. The preschool program offers full day and half day programs. At approximately 10:05am LPA and facility representative started the tour of the physical space. Indoor/Children's Area: Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean. Cleaning compounds were stored in a key locked cabinets located in each classroom. Cleaning products were also stored in the staff restroom. The door leading to the staff restroom was equipped with a chain lock. No poisons were stored on the premises. Furniture/equipment is in good condition at the time of this inspection. Classrooms and office spaces was free of flies, other insects, rodents. The classroom had tables and chairs to meet children’s needs. LPA observed the classroom had a dramatic play area, science area, library and additional areas for instruction. The classroom had diverse play equipment, along with multiple blocks, puzzles and age appropriate materials. Children's belongings are kept in cubbies along the wall as you enter classroom. Trash cans for solid waste have tight fitting lids. All materials and surfaces are toxic free. No fireplaces were present. LPA observed carbon monoxide detectors, smoke detectors and fire extinguishers in each classroom. The Center had working telephone service on the premises. There is an isolation room for children who become ill while in care located in the main office. The facility maintains a comfortable temperature at all times. Report continued on page two

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

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: PSD-CRESTLINE HEAD START	FACILITY NUMBER: 364813457
	VISIT DATE: 04/27/2023

NARRATIVE

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Each classroom had a water dispenser/disposable cups for the children. Smoking prohibited on the premises, daily inspection for illness is completed by the staff each day. LPA did not observe prohibited child care items at this time. Firearms/weapons are not allowed or stored on premises. There are no bodies of water on the premises. The facility provides, breakfast, lunch and a snack to the children. All meals are prepared in the kitchen.
Napping
Mats were observed in good condition. Bedding and linens were individually stored in individual cubbies, child's used bedding does not come into contact with other bedding.
Restrooms
There are two children's restrooms at the facility, one in each classroom. Each restroom had one toilet and a one sink. All restrooms areas were in safe and sanitary operating condition at the time of this inspection. LPA's observed paper towels, and soap available for the children. Classroom two also has a staff restroom.
Kitchen:
The kitchen is located in the same building as classroom two. The kitchen was inaccessible to the children in care via a half door. LPA observed the chemicals and sharps were stored on high shelves. The kitchen area was clean and sanitary at the time of this inspection.

Outdoor
The Center has a large outdoor play area which is fully enclosed. LPA observed a drum set, water table, hula hoops, balls, bikes and sand box for the children. Due to the recent winter storm the climbing structure in the outdoor play space sustained damage. At the time of this inspection a six foot chain link fence was installed which prevented the children from access to the climbing structure. When the children are outside drinking water is provided by an igloo water container and cups.

The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393L), menu, car seat law (PUB 269), emergency disaster plan, earthquake preparedness checklist.
Other: Electrical outlets are inaccessible, there are no recalled and or prohibited toys or sleep/play equipment observed on the premises. Report continued on page three

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: PSD-CRESTLINE HEAD START	FACILITY NUMBER: 364813457
	VISIT DATE: 04/27/2023

NARRATIVE

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Report continued from page two

LPA reviewed six staff files and ten child files. Based on LPAs review, child files were complete and contained all required information. One of six staff files was missing the mandated reporter training which was AB1207 compliant. The staff had completed the current general mandated reporter training however was missing the specific training for child care providers as required. A technical advisory notice was issued. LPA reviewed the electronic sign in and out records. Records were accurate and reflected the current attendance. Per conversation with facility representative, the current Administrator listed on this report is no longer with PSD. LPA advised the facility to submit the required paperwork to the Department so the Administrator can be updated. A second advisory notice was issued.

Facility Records
LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility. LPA observed a current roster, disaster drill log, a staff member was present with current CPR/First Aid training.

Health Related Services
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.
At the time of this inspection zero medications were being administered to the children in care.

The following was discussed with the facility representative:
Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Director shall permit the Department to inspect the facility, and to privately interview children or staff, to determine compliance with or to prevent violations of laws 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.

Report continued on page four

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: PSD-CRESTLINE HEAD START	FACILITY NUMBER: 364813457
	VISIT DATE: 04/27/2023

NARRATIVE

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Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address 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 family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm

Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address 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 family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Report continued on page five

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: PSD-CRESTLINE HEAD START	FACILITY NUMBER: 364813457
	VISIT DATE: 04/27/2023

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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

Based on LPA observations and record review two advisory notices were issued to the facility.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Natalia Mundo-Romo.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023

LIC809 (FAS) - (06/04)

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