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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843322
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:54:56 PM


Document Has Been Signed on 03/15/2023 02:54 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:OCS OUR LADY OF THE ASSUMPTION PRESCHOOLFACILITY NUMBER:
364843322
ADMINISTRATOR:SUSAN LONGFACILITY TYPE:
850
ADDRESS:796 W. 48TH STREETTELEPHONE:
(909) 475-5437
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:40CENSUS: 28DATE:
03/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:52 AM
MET WITH:Tish Godsy, PrincipalTIME COMPLETED:
03:08 PM
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Licensing Program Analyst (LPA) Maddox met with Acting Director, Tish Godsy today for the purpose of conducting an unannounced Required 1 yr inspection. Present today were 18 children and 4 staff persons. This Preschool Program is held on the campus of Our Lady of Assumption Christian School and occupies l classroom, waivers on file to share bathroom and play yard. DAYS AND HOURS OF OPERATION: MONDAY THROUGH FRIDAY, 7:30AM TO 5:30PM.

**LPA observed age appropriate furniture, equipment, toys and materials. The classrooms was observed to be clean and safe and free of any Health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. Children's belongings are kept on coat hooks along the wall in the classroom. Drinking water is available inside the classroom in the form of water bottles and a water pitcher that's filled up from the office.

**The children's bathroom is located in the rear of the classroom in hallway area. There are 2 separate bathrooms with 1 Toilet and 1 sink in each with an additional bathroom in classroom B. The staff rest-room is located near the office in a separate building. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate. - Waiver on file to share bathroom with Kindergarten class.

**Children nap on mats covered with linens. Mats are stored in individual cubbies so that each child's bedding is identifiable and no child's used bedding comes into contact with other bedding. Bedding and linens are laundered weekly and as needed.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
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 6


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: OCS OUR LADY OF THE ASSUMPTION PRESCHOOL
FACILITY NUMBER: 364843322
VISIT DATE: 03/15/2023
NARRATIVE
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**Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes rubber matting under climbing structures for cushioning material, sufficient and adequate shade is available. Large play equipment and climbing structure was securely anchored. The area was observed to be free of debris. Outside Drinking water is available in the form of a water fountain. There are no bodies of water observed on the premises. The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area. The play yard has wrought iron fencing in place greater than 5 feet high.

**Center serves snacks only, parents have the option of providing lunch or purchasing lunch from school caterer. - Waiver on file for Food Service.


**Required forms are posted according to Title 22 Regulations. LPA reviewed a sampling of Children's files for completion including current immunization's; Staff records were reviewed for current immunization's/Fingerprint clearances and associations/Mandated Reporter training/Educational Requirements/and other required forms. Director has current Pediatric CPR and First Aid (exp 8/13/20).

Sign in and out sheets were inspected and contain full legal signatures. LPA observed a fully stocked first aid kit; fully charged fire extinguishers; carbon monoxide detectors throughout the center. Fire Drill/Earthquake log is posted.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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 - None enrolled at this time
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: OCS OUR LADY OF THE ASSUMPTION PRESCHOOL
FACILITY NUMBER: 364843322
VISIT DATE: 03/15/2023
NARRATIVE
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Type B Citation issued for incomplete Staff and Children's files. LPA will return within 2 weeks for plan of correction


Notice of Site Visit must be posted for a period of 30 consecutive days. Exit interview conducted, Copy of this report was left with Director after signing.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 03/15/2023 02:54 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: OCS OUR LADY OF THE ASSUMPTION PRESCHOOL
FACILITY NUMBER: 364843322

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2023
Section Cited

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101221 Child's Records
(a) A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by file review conducted.
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Staff shall ensure missing forms are available for review by POC due date.
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Children's files missing PR, Parent's rights; Personal Rights; Immunization Records. LPA printed our form LIC 311 during inspection as a guide for required forms
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Type B
03/29/2023
Section Cited

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Personnel Records Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information.
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This requirement was not met as evidenced by file review conducted. Staff files missing Health Screenings, transcripts, Immunizations, TB exams
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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 KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 03/15/2023 02:54 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: OCS OUR LADY OF THE ASSUMPTION PRESCHOOL
FACILITY NUMBER: 364843322

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023

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
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Based on interview with staff, there is no evidence of Lead Testing.
POC Due Date: 03/29/2023
Plan of Correction
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Staff will contact necessary agency to schedule lead testing for water
Type B
Section Cited
WD
100700(c)(1)
Written Directives for Lead Testing
(1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview with staff, there is no evidence of Lead Testing.
POC Due Date: 03/29/2023
Plan of Correction
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Staff will contact necessary agency to schedule lead testing for water
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 KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6