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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750017
Report Date: 08/01/2019
Date Signed: 08/01/2019 12:29:53 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:CHAMPIONS@RALPH BAKER 21ST CENTURY LEARNING CENTERFACILITY NUMBER:
367750017
ADMINISTRATOR:MURRAY, KEITHFACILITY TYPE:
840
ADDRESS:15456 EL EVADO RDTELEPHONE:
(760) 338-9359
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:60CENSUS: 0DATE:
08/01/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Keith MurrayTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Neal met with the Site Supervisor, Keith Murray for the purpose of conducting a Pre-licensing inspection of the School Age center. During this Pre-Licensing inspection, LPA toured and measured center indoors according to the facility sketch. Center is located at the Ralph Baker 21st Century Learning Center. The center consists of 3 rooms: the stem room/studio 7, multi-purpose room (MPR)/cafeteria and library/innovation studio. The stem room will be used before school, and the MPR will be used after school and for extra space. The library will be utilized when the other two rooms are unavailable. Center will operate Monday through Friday 6:00am to 8:00am and 2:00pm and 6:30pm.
LPA observed age appropriate furniture, equipment, and materials. The rooms were observed to be clean, safe and free of any health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. Staff will use "Ring" doorbells for entrance that electronically notify staff of arrivals to the center. There are water fountains in the hallway outside the multipurpose room. Medications will be stored in a locked storage cabinet. Storage space is a room located on the right side of the MPR. Emergency backpack will travel with staff from room to room and be stored in a bucket. Staff restroom is located at the end of the hall to the right.
Furniture and equipment was observed to be in good condition, free of sharp, loose or pointed parts in all rooms. There is a moveable bin with a lid. Boys and girls bathrooms (boys=2 urinals, 3 toilet stalls, 4 sinks; girls = 5 toilets stalls, 3 sinks) are separate and located in the hallway across from the MPR and Stem room (studio 7 classroom).
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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: CHAMPIONS@RALPH BAKER 21ST CENTURY LEARNING CENTER
FACILITY NUMBER: 367750017
VISIT DATE: 08/01/2019
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Classrooms are of the appropriate square feet to accommodate children within capacity specified by regulations. The outside play yard consists of a grassy area, concrete and blacktop with basketball courts and other activities. There is a large shaded play structure in the left corner of the playground with slides that has a padded surface underneath. Amphitheater seating is available and there is an area for shade. Water fountains are also available.
Per Title 22, Section 101538.2(c)(1) and Health and Safety Code Section 1596.806(b) regulations, outdoor activity space is located on a functioning public school site, therefore, the site is exempt from square-footage and fencing requirements for child care centers.
The facility serves afternoon snack. The facility's snack menu is posted on a board that will be kept at the entrance in the room. The kitchen in the MPR is inaccessible by key lock and will not be used. Fire extinguisher, smoke detector and carbon monoxide detector were all observed to be maintained. Applicant was informed to conduct and maintain Fire/Earthquake drill logs. LPA's observed required forms posted on a board that will be kept where parents can see it. Director's Pediatric CPR and First Aid is current. Mandated Reporter training for child care was completed by the Director. Site supervisor was reminded that all staff must complete the Mandated Reporter training every 2 years. The facility has sign in/sign out sheets.

This facility provides Incidental Medical Services – IMS. 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/childquanda.htm
Staff are aware of required forms for children and staff files as well as forms that shall be posted after licensure.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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: CHAMPIONS@RALPH BAKER 21ST CENTURY LEARNING CENTER
FACILITY NUMBER: 367750017
VISIT DATE: 08/01/2019
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**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility are aware of situations that present the greatest danger to children.

Site supervisor was reminded to access the licensing website at ccld.ca.gov to obtain information about the most recent regulatory changes and the Quarterly Updates.

Licensure will be issued upon the following conditions:


1. Documentation of Fire Clearance granted to school must be submitted to Licensing.
2. Updated facility sketches (yard and center) will be submitted to licensing.

Once corrections have been verified, the application for the school age center will be submitted for approval. Applicant is advised that all corrections are due within 30 days or the application may be withdrawn.

Exit interview was conducted and a copy of this report was given to Site Supervisor, Keith Murray.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
LIC809 (FAS) - (06/04)
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