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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841130
Report Date: 10/07/2024
Date Signed: 10/07/2024 03:14:26 PM

Document Has Been Signed on 10/07/2024 03:14 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:MT. CALVARY LUTHERAN CENTERFACILITY NUMBER:
364841130
ADMINISTRATOR/
DIRECTOR:		KIMBERLY KOPECKYFACILITY TYPE:
840
ADDRESS:27415 SCHOOL ROADTELEPHONE:
(909) 337-7750
CITY:LAKE ARROWHEADSTATE: CAZIP CODE:
92352
CAPACITY: 12TOTAL ENROLLED CHILDREN: 9CENSUS: 9DATE:
10/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Facility Representative Kimberly KopeckyTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Zirbes met with Facility Representative Kimberly Kopecky for the purpose of conducting an unannounced Annual/Random inspection for the School Age Center. During the inspection, LPA observed nine school age children on site with two teachers and the Administrator. Based on LPA observation the Center was meeting the ratio and capacity regulations during this inspection. The school age component is operated out of one classroom (4). The Center is also licensed to provide care to preschool/toddlers (license number: 360908938). The Center has a kitchen, staff restrooms, staff office and outdoor activity space which are utilized by both components. The facility currently operates Monday through Friday 8:00am -5:00pm. The Center follows the Rim of the World School District calendar. The Center has an approved waiver regarding the outdoor activity space and commingling during the first and last hour.

Indoor/Children's Area: LPA toured and inspected the facility in accordance with the facility sketch with the Administrator at approximately 1:30pm. Child care center was observed to be clean, 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 are stored in closets outside of the classrooms. The cleaning products were located on inaccessible areas within the closets. LPA observed the indoor furniture/equipment was in good condition. Classroom was free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the classroom had art supplies, dramatic play area, library area and additional educational spaces. Children's belongings are kept in individual backpacks outside of the classroom. Trash cans for solid waste have tight fitting lids. Drinking water is readily available indoors via children's water bottles and a drinking fountain in the classroom. All materials and surfaces are toxic free, window screens in good repair and free of debris. LPA observed carbon monoxide detectors throughout the licensed space.
Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MT. CALVARY LUTHERAN CENTER
FACILITY NUMBER: 364841130
VISIT DATE: 10/07/2024
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Report continued from page one
Restrooms: The School age program has a total of two restrooms. One for the children and one for the staff. Classroom 4 has one toilet, and two sinks. Toilet and sinks were functioning properly, sanitary and are age appropriate. Paper towels and soap were available to the children.
Meals: The families of the enrolled children provide two snacks, and a lunch for their child.

Outdoor: LPA inspected the outdoor play space for health, safety, cushioning material, good repair and age appropriateness. The space contained two climbing structures and additional outdoor play materials were available in a locked storage container. The climbing structures were placed on wood chips and were anchored to the ground. The outdoor areas were clean and free of hazards at this time. Water is accessible to the children via individual water bottles.

Child/Personnel Records
LPA reviewed five child records and four personnel files during this inspection. Child and Personnel records were complete and contained all required information.

Facility Records


LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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: MT. CALVARY LUTHERAN CENTER
FACILITY NUMBER: 364841130
VISIT DATE: 10/07/2024
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Report continued from page two

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

As a result of this inspection, zero advisory notices or citations were issued.

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 Kim Kopecky.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC809 (FAS) - (06/04)
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