364840739-1-16-2020-12-CC-JNEL-BKVV27-20200116150242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364840739
Report Date: 01/16/2020
Date Signed: 01/16/2020 03:02:51 PM

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:	PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL		FACILITY NUMBER:	364840739
ADMINISTRATOR:	STEPHANIE RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	17251 DANTE STREET		TELEPHONE:	(760) 951-1425
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	32	CENSUS: 26	DATE:	01/16/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Stephanie Hernandez		TIME COMPLETED:	03:15 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	Licensing Program Analyst (LPA) Neal met with the facility Site Supervisor, Stephanie Hernandez, for the purpose of a Required Annual inspection of the Head Start preschool. LPA observed 26 children and 2 teachers, 2 assistants present at the facility. The preschool consists of 2 classrooms. The facility operates from 7:00 am to 5:00 pm. There is 1 half day classroom (Mon-Thurs. 8 to 1130 and 12:30 to 4pm) and a full day classroom (Mon. - Fri. 7am to 5pm). During this inspection, LPA toured the facility, observed equipment/supplies, and reviewed a sample of children and staff files. Current Pediatric CPR and First Aid was observed. Furniture and equipment were inspected for age appropriateness and good repair. Rooms were observed clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings in each classroom. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water dispensers and disposable cups. LPA observed a sufficient quantity of cots available for napping children. The bedding is stored separately and per directly is washed weekly. Each classroom has a backpack for the storage of medications which is kept in hanging in the classrooms. First Aid Kits were observed in each classroom. There is an Emergency Survival Kit Bin kept sealed in the hallway. Fire extinguisher, smoke detector and carbon monoxide detector were observed to be operable condition.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL	FACILITY NUMBER: 364840739
	VISIT DATE: 01/16/2020

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
26
27
28
29
30
31
32

Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. LPA observed a small play structure with shade provided and a cushioned surface. There is also a large play structure with wood chips underneath. Both structures are securely anchored. There is a sandbox and a grass area for active play as well. The playground was observed to be free of debris. Drinking water is available in the form of a water cooler and disposable cups. There are no bodies of water on the premises. There are 2 storage sheds (locks observed).

Children are inspected for illnesses as they arrive. There is a separate room for isolation and care of ill children in a room adjacent to the site supervisor's office. There is a separate cot with fresh linens available for each ill child. LPA inspected and observed the children's bathroom. There are 3 toilets and 3 sinks, functioning properly and age appropriate. LPA observed soap, toilet paper and paper towels readily available. Staff restrooms are located in the hallway outside of the classroom.

There is a clean, fully equipped kitchen with refrigerator, freezer, convection oven, microwave, and sink. The facility provides breakfast, lunch and afternoon snacks. Menus are posted. LPA observed allergy list posted. There are also allergy lists in each classroom. LPA observed an appropriate amount of food and snacks. The chemicals are kept separate from the food. Cleaning supplies are kept in the custodial closet outside of the kitchen.

Teacher/child ratios were observed as well as sign in/out sheets. Fire/earthquake drills are current. Center Director was reminded to access the Licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL	FACILITY NUMBER: 364840739
	VISIT DATE: 01/16/2020

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
26
27
28
29
30
31
32

Medications are stored in a backpack (locked and stored at door of each classroom). A review of medication policy indicated that prescription medication is administered only with parent's written permission. The management staff administers medication and documents the dosage, date and time onto a log. Medication is brought and taken home by the parent daily or stored in the backpack. Medication is properly labeled and stored in its original container.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies. 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

Additional forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov. Center informed to review updates/regulations on the department website.

No deficiencies cited according to Title 22 Regulations.

Exit Interview conducted and a copy of the report was read and provided to the Site Supervisor.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle Neal	TELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3