364819466-8-15-2023-12-CC-KZIS-CUQVQP-20230815163841

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364819466
Report Date: 08/15/2023
Date Signed: 08/15/2023 04:38:55 PM

Document Has Been Signed on 08/15/2023 04:38 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:	CHAMPIONS IRWIN/ACADEMY		FACILITY NUMBER:	364819466
ADMINISTRATOR:	MURRAY, KEITH		FACILITY TYPE:	840
ADDRESS:	14907 S MOJAVE DRIVE		TELEPHONE:	(760) 955-2808
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	25	CENSUS: 23	DATE:	08/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Facility Representaitve Erin Ruiz		TIME COMPLETED:	05:00 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 August 15, 2023 at 12:15 p.m. Licensing Program Analyst (LPA) Zirbes met with the Facility Representative Erin Ruiz. The purpose of the inspection was to conduct an unannounced required one year inspection. LPA disclosed the purpose of the inspection to the Facility Representative. Present during today’s inspection were 23 school age children, and three teachers. The school age program consists of one classroom located on Irwin Academy Campus. The program operates Monday to Friday. Mornings - 6:30am to 8:45am; Afternoons - Mon. - Thur. 12:04pm to 6:30pm and Fridays 1pm to 6:30pm. 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. Cleaning compounds are stored in the classroom. The cleaning products were stored in a cabinets equipped with key locks. The Center was free of flies, other insects, or rodents. Each classroom was equipped with tables and chairs to meet children’s needs. All play equipment and materials used by children are age-appropriate, children have individual cubbies labelled with their names for storage of personal belongings. Trash cans for solid waste have tight fitting lids. All materials and surfaces are toxic free. No fireplaces were present in the center classrooms. Carbon monoxide detectors and smoke detectors are located in the classroom and is a dual alarm connected through the elementary school. A fire extinguisher was located in the Center. The Center had working telephone service on the premises. There is an isolation area for children who become ill while in care. The facility maintains a comfortable temperature at all times. Sign in/out sheets were available and are completed each day. Sign in an out sheets included information for school drop off and pick up. Smoking prohibited on the premises. Staff complete daily inspections for illness. LPA did not observe prohibited child care items at this time. All electrical outlets were inaccessible. Firearms/weapons are not allowed or stored on premises. There are no bodies of water on the premises. The Center has the menu posted. Children have access to water while in the classrooms via bottle water dispenser and cups. Restrooms: The Center utilizes the restrooms on Irwin Academy Campus. The restrooms are located across from the playground. Restrooms were age appropriate and contained paper towel and soap dispensers. Additional restrooms available for the staff. 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: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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 08/15/2023 04:38 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: CHAMPIONS IRWIN/ACADEMY	FACILITY NUMBER: 364819466
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above when the Center did not have its drinking water tested for lead contamination levels by January 1, 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/29/2023
	Plan of Correction
1 2 3 4	Per facility representative, the required lead testing will be scheduled by 8.29.23. An email will be submitted to the Department verifying the lead testing inspection has been scheduled.

Type B

Section Cited

CCR

101217(a)(6)

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: (6) Documentation of the educational background, training and/or experience specified in this chapter. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in one of three staff files reviewed (S2) did not contain documentation of S2 educational background, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/29/2023
	Plan of Correction
1 2 3 4	Per facility representative, documentation of S2s education will be added to the staff file. A copy of S2s education will be submitted to the Department. The Center will utilize the LIC 311 or another checklist to ensure the staff files contain all required information. The center will conduct a review of the staff files to ensure completeness.

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: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: CHAMPIONS IRWIN/ACADEMY	FACILITY NUMBER: 364819466
	VISIT DATE: 08/15/2023

NARRATIVE

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Report continued from page one

Food Service: The Center provides two snacks for the children. Lunches are provided by the families. Outdoor: The Center utilizes the playground on Irwin Academy. The playground is located to the right of the classroom and it is gated. The outdoor play space has climbing structure, basketball hoops, grass area/cement area for large motor activities and a shaded area. The climbing structure was placed on cushioning material. LPA observed the cushioning material under the climbing structure had three areas where the cushioning material was missing or cracked. The areas were less than eight inches wide. Per conversation with the facility representative, the school is aware of the issue and has a plan to replace the material. Zero bodies of water were observed. Drinking water is readily available to the children when outside via a drinking fountain.

During the inspection teacher child ratios were observed, and found to met the requirements. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
Staff/Child Records
LPA reviewed five child records and three staff member records during this inspection. Child files were complete and contained the required documentation. Based on LPA review, two of three staff files reviewed were missing documentation of the TB test when LPA initially reviewed the staff files. During the inspection documentation of the TB results were received. One of three staff files (S2) reviewed did not renew the mandated reported training every two years as required. S2 mandated reporter certificate expired 7/26/2023. In addition, S2s file did not contain documentation of S2's educational background. S2 was identified as a teacher who provides supervision to the children. A type B citation was issued along with two technical violations. A staff member was on site who had current CPR/First Aid.
Facility Records
LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.
Per conversation with facility representative, the Center did not have its drinking water tested for lead contamination levels by January 1, 2023. A type B citation was issued. Per conversation with the facility staff member, the Administrator on file with the Department is no longer working at this site. LPA advised the Center to submit the required documentation to the Department so the Administrator can be updated.
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: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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: CHAMPIONS IRWIN/ACADEMY	FACILITY NUMBER: 364819466
	VISIT DATE: 08/15/2023

NARRATIVE

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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
Postings:
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.
Topics Discussed:
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 center, 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.

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: www.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.

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.
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: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

Page: 7 of 9

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: CHAMPIONS IRWIN/ACADEMY	FACILITY NUMBER: 364819466
	VISIT DATE: 08/15/2023

NARRATIVE

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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.

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 insectionprocess@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/inspection-process.

Based on LPA observations and record review two type B citations and four technical advisory notices were issued.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility representative Erin Ruiz.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC809 (FAS) - (06/04)

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