364813826-1-25-2023-12-CC-KZIS-CNF2YJ-20230125164845

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364813826
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:49:19 PM

Document Has Been Signed on 01/25/2023 04:49 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:	KNOTT'S SKY PARK PRESCHOOL		FACILITY NUMBER:	364813826
ADMINISTRATOR:	WILKIE, LEA		FACILITY TYPE:	850
ADDRESS:	6897 EL SOL AVENUE		TELEPHONE:	(760) 367-5772
CITY:	TWENTYNINE PALMS	STATE: CA	ZIP CODE:	92277
CAPACITY:	30	CENSUS: 18	DATE:	01/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Director Christine Ilac and Facility Representative Lilana Kaupiko		TIME COMPLETED:	05:10 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 January 25, 2023, Licensing Program Analyst (LPA) Zirbes met with the Director Christine Ilac and Facility Representative Lilana Kaupiko for the purpose of conducting an unannounced required one year inspection. LPA toured and inspected the facility in accordance with the facility sketch. There were 18 preschool age children, and two teachers on site. Based on LPAs observation the facility was meeting the capacity/ratio requirements during this inspection. During LPAs inspection LPA observed staff 1 and staff 2 on site. Per LPAs record review, S1 and S2 are not currently associated to the Center. This poses an immediate risk to the health and safety of the persons in care. A type A citation was issued at the time of this inspection, Refer to LIC 809D. The preschool program is operated out of two classrooms (Main classroom and Kindergarten classroom). The center also operates Monday through Friday 6:30am -5:30pm . Indoor/Children's Area: Child care center was toured to ensure the 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. LPA observed the lower shelf on one cabinet in the main classroom had peeling paint and was showing signs of wear. LPA advised the facility representative that all furniture and equipment shall be maintained in good condition. A technical advisory notice was provided. LPA also observed the paint was peeling from one wall in the main classroom due to recent water damage from an extreme weather incident. A technical advisory notice was issued. LPA observed approximately four rips in the carpet throughout the classrooms. At this time the rips did not appear to pose a tripping hazard to the individuals in care. However LPA advised the facility representative to continue to monitor the floor of all rooms to ensure the surface is safe and clean. A technical advisory notice was issued. Cleaning compounds were stored in the cabinet under the kitchen sink. The kitchen is inaccessible via a locked dutch door, therefore the cleaning products were inaccessible to the persons in care. Per Licensee zero poisons are stored within the preschool. Classrooms were free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the Center has a variety of art supplies, dramatic play equipment, blocks, books and a wide variety of additional educational materials. 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: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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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Document Has Been Signed on 01/25/2023 04:49 PM - It Cannot Be Edited

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two for four staff members. S1 and S2 are not currently associated to the facility. S1 has been employed at the facility since 08/2019 and S2 has been employed since 07/2022 this poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/26/2023
	Plan of Correction
1 2 3 4	Transfer paperwork was submitted to the Department at the time of this inspection. The facility will monitor their facility associations to ensure that all staff/volunteers have requested a transfer or obtained a criminal record clearance.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/25/2023 04:49 PM - It Cannot Be Edited

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in four out of four staff files were incomplete and did not contain the required documentation such as immunization's, health evaluation, and education information. This poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/20/2023
	Plan of Correction
1 2 3 4	Per facility representative, the staff files will be audited and all required information will be added to the files.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
	VISIT DATE: 01/25/2023

NARRATIVE

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Report continued from page one

Children's belongings are kept in cubbies labeled with the children's names. Trash cans for solid waste have tight fitting lids. Drinking water is readily available indoors via water bottles provided by the parents/authorized representatives and water coolers/cups. All materials and surfaces are toxic free, window screens in good repair and free of debris. There is a working carbon monoxide detector, smoke detector and multiple fire extinguishers located throughout the Center. There was one bathroom in the preschool Center. Toilets and sinks were functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available.
There was working telephone service within the preschool. There is an isolation area for children who become ill. The facility maintains a comfortable temperature at all times. LPA observed the centers sign in/out sheets, which are completed daily. Smoking is prohibited on the premises. Teachers conduct daily inspection for illnesses. LPA did not observe prohibited childcare items during this inspection. Firearms/weapons are not allowed or stored on premises. LPA did not observe bodies of water on the premises. The Center provides two snacks a day and the authorized representatives provide the children with lunch. All snacks are stored in kitchen area of the Center.
Napping
LPA observed mats for the children. LPA observed the children's blankets/sheets are stored in a manner that does not allow different children's bedding to come into contact with each other. The parents or authorized representatives wash the children's bedding weekly.
Outdoor
LPA inspected the outdoor play space for health, safety, cushioning material, good repair and age appropriateness. The Center has one large outdoor play space that is maintained by the city. The outdoor space was enclosed by a chain link fence. The outdoor space has grass, cement riding track, sand area and an area with large climbing equipment. The climbing structures and swings were placed on wood chips and were anchored to the ground. LPA observed three of the four rubber swing seats had rips in the rubber material and were showing signs of wear. LPA advised the facility representative to remove the swing seats that were showing signs of wear. LPA advised the facility representative to continually monitor the environment and remove any objects that are not in a safe condition. A technical advisory notice was issued.
Water is accessible to the children via drinking fountain and personal water bottle while outdoors.
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: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
	VISIT DATE: 01/25/2023

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Report continued from page two
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

Child/Staff/Personnel Records
LPA reviewed nine child records. All child records included all required information. LPA reviewed a total of four staff files. Based on LPA's review, four of four staff files reviewed did not contain all the required documentation. All four files did not contain documentation of the required immunization's (TDAP, MMR, Flu) S3 and S4 files missing documentation that S3 and S4 have the educational background training or experience that qualified S3 and S4 as a fully qualified teachers. S1 files was missing LIC 9052, and S2 was missing documentation of the required health screening. Due to the missing documentation, the staff files were incomplete at the time of this inspection. A type B citation was issued for regulation, 101217(a) as this poses a potential risk to the children in care.

Facility Records

LPA and facility representative reviewed the LIC 311A Records To Be Maintained At The Facility. LPA observed a current roster, fire/disaster drill log (January 2023). A staff member was on site who had a current CPR/First Aid.
Posting Requirements
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), 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 four

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
	VISIT DATE: 01/25/2023

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 on the website: 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 center. 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Center shall permit the Department to inspect the child care center and to privately interview children or staff, to determine compliance with or to prevent violations of child care 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.

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.

LPA provided the facility with information regarding the requirements for Lead testing in Child Care Center (PIN 22-20-CCP)

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: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

Page: 12 of 13

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: KNOTT'S SKY PARK PRESCHOOL	FACILITY NUMBER: 364813826
	VISIT DATE: 01/25/2023

NARRATIVE

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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
As a result of this inspection, one type A citation was issued for regulation, 101170(e)(2). Civil penalties were issued. In addition, each report (documenting a Type A citation- that pose an immediate Health and Safety risk to children in care) shall remain posted for 30 days along with the Notice of Site Visit, Parents of any currently enrolled children and any newly enrolled children for the following 12 months shall sign form LIC 9224 (Acknowledgment of Receipt of Licensing Reports), a copy shall be kept in each child’s file. Failure to meet the posting requirements shall result in an immediate $100.00 civil penalty for each child’s parent who did not sign the LIC 9224 (Acknowledgment of Receipt of Licensing Reports)
One type B citation was issued along with technical advisory notices.

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 Liliana Kaupiko

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

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