<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 144802244
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:53:34 PM

Document Has Been Signed on 08/27/2024 01:53 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ICSS - ROUND VALLEY STATE PRESCHOOLFACILITY NUMBER:
144802244
ADMINISTRATOR/
DIRECTOR:		KAT DUNCANFACILITY TYPE:
850
ADDRESS:ROUTE 2, PINE CREEK ROADTELEPHONE:
(760) 387-2047
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
08/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Robin Murray, TeacherTIME VISIT/
INSPECTION COMPLETED:
02:00 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 8/27/2024, Licensing Program Analysts (LPAs) Crystal Ali and Carol Heath arrived at the facility to conduct an Annual Random Inspection. LPAs were met Robin Murray (Teacher) and permitted to enter the facility. LPAs toured the facility in accordance with the facility sketch with Robin. During the inspection, LPAs observed 0 children and 2 staff providing care and supervision. Facility operates Monday through Friday from 8am-12pm.
Staffing Ration and Capacity: Facility consists of one classroom, one staff bathroom (locked), one children bathroom, kitchenette area, and one outdoor play area. Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met.
Physical Plant: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPAs observed sign-in sheets completed by each parent/guardian per requirements. LPAs observed individual storage for children's belongings. The children have access to water via individual water bottles filled with tap water from classroom sink. Smoke detectors, carbon monoxide detectors, and fire extinguisher were observed and in operable condition. Smoke and carbon monoxide detectors are operating according to Fire Marshall standards. There are three complete first aid kits in the classroom. Two trash cans with tight-fitted lids were not observed. There is a fish tank with no fish in it. There is a hamster (Ms. Daisy). Her cage is cleaned weekly by Teacher.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICSS - ROUND VALLEY STATE PRESCHOOL
FACILITY NUMBER: 144802244
VISIT DATE: 08/27/2024
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
Napping: The facility is not required to provide napping. However, if a child wants to nap the facility while provide napping material for the child to nap in the reading area on carpet.
Kitchen: There is a mini kitchenette in the classroom. Equipped with a refrigerator/freezer, and microwave oven. There is no food program for the preschool. The facility provides morning snacks. Allergy lists are posted on refrigerator and in their child file. Teacher states there is 1 child that has a peanut allergy ad an epi-pen is clocked up in right cabinet near sink. Both staff are trained is using the Epi-Pen. Chemicals, soaps, detergents, cleaning compounds, or similar substances are stored separately from food located in the staff bathroom/storage area that is inaccessible to the children. LPAs observed a food preparation area kept clean and free of litter and rubbish. There are menus observed for snack time, preschool does not have a full day program. Daily activity schedules posted showing snack times, and specific activities.
Fire Extinguisher: Emergency Drills are conducted at least every six months, and the last drills were not available to LPAs. The fire extinguishers (3A40BC) are reading in green and meets the Fire Marshall Codes and Standards (last serviced 11/21/23). One fire extinguisher is at the back staff bathroom door of classroom. Fire Drill completed 8/20/24 at 9:15am and Earthquake drill completed 8/27/24 at 9am.
Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Boys and Girls share bathroom that is monitored by staff. The bathroom has 1 sink and 1 toilet. The sink and toilet work properly. The bathroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff. Children have a pair of extra clothes due to potty training needs.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICSS - ROUND VALLEY STATE PRESCHOOL
FACILITY NUMBER: 144802244
VISIT DATE: 08/27/2024
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
Medication: LPAs did observe a medication policy. LPAs reviewed the requirements for IMS policy with teacher. The facility teachers do pass out medication. Currently no children are on medication. As stated before, there is one child with peanut allergy and Epi-Pen in the facility locked up. The child does have the proper documentation to administer the Epi-Pen and staff has been trained. Children are inspected for illnesses as they arrive for wellness check. Isolation area is in the library area of classroom away from the rest of the children.
Transportation: The facility does not provide transportation for the children.
Lead Testing/Drinking Water: LPAs observed copy of lead testing in the facility file. LPAs have a requested the most current lead testing results. Administration office rep stated they have a copy at the district office and will provide a copy to LPA Ali via email.
Outdoor Activity Space: Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. The play yard has two sections, one with water table and toys, second area has large play yard equipment and sand play area. There are two tables for children , five shaded areas, there are several tricycles. The facility will continue to provide 100% supervision when outside in the playground. Children are provided water for their individual drinking bottles. There is adequate shaded area for rest with the large trees. The playground is well-fenced, around and no bodies of water were observed in the outdoor play area.
Records/Documentation: LPAs reviewed with facility representative the LIC 311A, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Child files are in compliance. Staff file are in compliance. Parent board is in compliance.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICSS - ROUND VALLEY STATE PRESCHOOL
FACILITY NUMBER: 144802244
VISIT DATE: 08/27/2024
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
There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor/Teacher, Robin Murray.

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.

Criminal Record Clearance - 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICSS - ROUND VALLEY STATE PRESCHOOL
FACILITY NUMBER: 144802244
VISIT DATE: 08/27/2024
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
Lead Testing – Child Care Centers (CCC)
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
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.

Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on
their purchased equipment.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICSS - ROUND VALLEY STATE PRESCHOOL
FACILITY NUMBER: 144802244
VISIT DATE: 08/27/2024
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
Incidental Medical Services (IMS) - Child Care Centers
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/.
PIN 22-05-CCP

MyChildCarePlan.org – Child Care Centers
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.
Subscribe to CCLD important information - Child Care Centers
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 7