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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808741
Report Date: 09/03/2026
Date Signed: 09/03/2026 03:49:52 PM

Document Has Been Signed on 09/03/2026 03:49 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:ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUSFACILITY NUMBER:
153808741
ADMINISTRATOR/
DIRECTOR:		ROSIE MARIE BORQUEZFACILITY TYPE:
850
ADDRESS:300 FRANKLIN STREETTELEPHONE:
(661) 854-6560
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 24TOTAL ENROLLED CHILDREN: 21CENSUS: 2DATE:
09/03/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Rosie Mariie Borquez, Principal and Dolores Valadez, Master TeacherTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On Thursday, 9/3/2026 Licensing Program Analyst (LPA), Isabel Ortega mett with Rosie Mariie Borquez, Principal Master Teacher, Dolores Valadez and conducted an Annual Random Inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed two children in the afternoon session with two staff providing care and supervision. Facility operates in one classroom referred to as the preschool center serving ages three years to five-year-olds. Center is located on an Elementary School premises- Sierra Vista., the facility has a playground waiver.

An isolation takes place by the teacher's desk. Children have the option for rest time and quiet time if needed. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms are cleaned, restocked of toiletries by staff as needed and on-site custodian disinfects and sanitizes daily.

Napping: Children do nap in the facility since is a half day program.
Lady King
Isabel Ortega
DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 09/03/2026
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The furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and AC ventilation were evaluated. LPA observed individual storage for children's belongings. The classroom consists of purchased filtered water from a white water dispenser (LPA observed five-gallon jug for indoor and outdoor drinking water is provided in an red water igloo container. The facility provides individual disposable cups. According to facility water is not utilized for food preparation or for drinking.

Facility operates two sessions: Monday through Friday first session. from 7:55 a.m. to 11:00 a.m. and the second session 11:30 am. to 2:30 p.m. Facility provides morning session with breakfast, and snack. The afternoon session is provided with lunch and afternoon snack.
Facility has all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, Car seat information, and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, carbon monoxide were observed to be operating properly. The fire extinguisher (2A10BC) is reading in green and was serviced on 6/01/2026 (LPA observed a blue tag). The carbon monoxide was found to be working properly.

Trash cans with tight lids were observed. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. A refrigerator is adequately equipped, clean, and free from hazards. There is hot running water in the kitchen area.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 09/03/2026
NARRATIVE
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Cleaning supplies are out of reach of children.

Emergency Drills are conducted every sixth month last drill was conducted and documented on 8/27/2026 at 2:00 p.m. Food allergies are noted and are posted in the food preparation area and in each class. The menu is posted in the main office, and parents may request a tangible copy per request. Menu is also posted in the classroom.



The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. During outdoor play children are provided with filtered water jug container (disposable cups are available). There is adequate shade area for rest. The playground is fenced around, and no bodies of water observed in the outdoor play area.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.

Staff are currently certified in Pediatric CPR/First Aid EMSA approved which does not expire until 8/03/2028. Childcare Provider Mandated Reporter (AB1207) training is dated 07/03/2026
The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 09/03/2026
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For IMS information see PIN 22-02-CCP. 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-carecenters/.
All staff are required to take the Child Care Provider Mandated Reporter (AB1207) training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. According to facility documentation all staff are aware they are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot line at (800) 540-4000.


NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 09/03/2026
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For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a


violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an
Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition
or Both
2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible
by the child's authorized representative. Menus for the past 30 days must also be available upon request.
3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are
provided care in the facility. The roster shall include the name, address, and daytime telephone number of
the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall
be available to the licensing agency upon request.
4. Entrance Checklist for Child Care Center: LPAs advised that forms, regulations, and quarterly
updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.
5.Pediatric First Aid and CPR:. Pediatric First Aid and CPR: American Heart Association or American Red
Cross or Emergency Medical Services Authority (EMSA) Certification and at least one person trained in
Pediatric First Aid and CPR must be present must be renewed every two years.
8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or
volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles
or influenza declination
9. Children’s Records: must be available for review; including but not limited to, the following: Name,
address, and telephone number of the child's authorized representative and of relatives or others who can
assume responsibility for the child if the authorized representative cannot be reached when necessary.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ARVIN STATE PRESCHOOL SIERRA VISTA CAMPUS
FACILITY NUMBER: 153808741
VISIT DATE: 09/03/2026
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10. Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC
9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee
Rights, LIC 501 Personnel Record, Mandated Child Abuse Certification, MMR, TDAP, TB, influenza, or
influenza declination.
11. Isolation- When a child is ill, he/she shall be separated from other children, and remain separated.
12. Annual fees must be paid promptly and by the due date or a late fee shall be assessed and/or the license
shall be terminated.
13. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and
within seven (7) days in writing (refer to LIC 624).
14. Fire and safety drills must be performed every six (6) months and documented for review by the
Department.
15. The fire extinguisher type 2A-10BC must be serviced annually or purchased yearly often as necessary and carbon
monoxide detectors should be checked, and batteries replaced as needed. after 10 years the sectors shall be be replaced.

No deficiencies issued today. An exit Interview was conducted with facility staff. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

A copy of this report must be made available to the public for 3 years. The Notice of site visit shall be visibly posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2026
LIC809 (FAS) - (06/04)
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