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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818052
Report Date: 06/13/2019
Date Signed: 06/13/2019 11:25:46 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:VALLEY COMMUNITY CHAPEL SCHOOL AND DAYCAREFACILITY NUMBER:
364818052
ADMINISTRATOR:BALDWIN, LISAFACILITY TYPE:
840
ADDRESS:59025 YUCCA TRAILTELEPHONE:
(760) 365-9049
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:30CENSUS: 20DATE:
06/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Lisa Baldwin TIME COMPLETED:
11:45 AM
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Licensing Program Analyst, Victoria Hunt conduct an unannounced case management visit for the purpose of changing the classroom in which the school age program will operate and to add a room to the license. During today’s inspection, LPA Hunt met with director, Lisa Baldwin. This facility operates year around, Monday through Friday, 6:00 AM to 6:00 PM.

The school age program will be changed from the Social Hall room #A7 to classrooms B4 and B5.
The facility has been granted approval clearance by the fire department for the licensure of classroom B4 this on 06/12/19. Classroom B5 was previously licensed and there are no changes to the fire inspection clearance.

Indoor activity area measurements:
Classroom #B4: 26.04 x 23 = 598.92
Total indoor activity space: 598.92 divided by 35 = 17 children

Classroom #B5: 34.04 x 23 = 782.92
Total indoor activity space: 782.92 divided by 35 = 22 children

Outdoor Play Space: 241 x 54.11 = 13040.51 divide by 75 = 174 children for the play yard that is attached to the school age program. Children will utilize the play area that is surrounded by wrought iron and chain link fence. The facility is requesting that the children also be able to use the black top as an alternate play space. (Facility will submit waiver for school age program to share blacktop outdoor space with preschool program). Measurements for the Outdoor Play Space for the blacktop area remain the same and can accommodate 159 children.


SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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: VALLEY COMMUNITY CHAPEL SCHOOL AND DAYCARE
FACILITY NUMBER: 364818052
VISIT DATE: 06/13/2019
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There are two bathrooms observed in classroom B4 with two sinks and two toilets in which children will utilize. Staff will use the isolation bathrooms near the offices.

Exit interview conducted with the Site Supervisor, Lisa Baldwin. A Notice of Site Visit was posted on parent board and should remain for 30 days.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
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