157750004-11-1-2023-12-CC-BBEO-CX6VKX-20231101163105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157750004
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:42:11 PM

Document Has Been Signed on 11/01/2023 04:42 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:	HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER		FACILITY NUMBER:	157750004
ADMINISTRATOR:	GUISELA GIRON		FACILITY TYPE:	850
ADDRESS:	100 EAST E STREET		TELEPHONE:	(661) 823-8826
CITY:	TEHACHAPI	STATE: CA	ZIP CODE:	93561
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 16	CENSUS: 6	DATE:	11/01/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Bromiley, Sarah		TIME COMPLETED:	12:56 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 11/01/2023, Licensing Program Analyst (LPA) Beneroso met with the facility’s Lead Teacher, Sarah Bromiley for the One Year Required inspection for the preschool license in accordance with the facility sketch. The center is licensed for a Toddler Component, but no Toddlers were present at the center during inspection. A tour of the facility was conducted. Upon arrival, LPA observed 6 preschool age children present children and 3 teachers on the premises providing care and supervision. The hours of operation are 7:45AM - 5:15PM Monday - Friday. Incidental Medical Services (IMS) were discussed. Indoor/Children’s Area: There is currently one classroom operating in the facility. The room was observed to be clean, safe, sanitary and in good repair; floors of all rooms have a surface that is safe and clean. Cleaning compounds are made inaccessible, they are located in the center’s office. They are stored in cabinets with safety latches. Furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, and personal belongings. There is an assigned area for sick/ill in the main office. All indoor passageways, stair ways, incline, ramps, open porches, and other areas of potential hazard are kept free of obstruction. There is a working telephone on the premises. Facility maintains a comfortable temperature at all times.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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

Document Has Been Signed on 11/01/2023 04:42 PM - It Cannot Be Edited

Created By: Barbara Beneroso On 11/01/2023 at 12:33 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER	FACILITY NUMBER: 157750004
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(a)

Buildings and Grounds

(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed bathoom in classroom to be clogged and overflowing which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/07/2023
	Plan of Correction
1 2 3 4	Site Supervisor agrees to submit proof of bathroom in classroom being fixed (receipt, pictures, video, etc) to LPA Beneroso no later than 11/07/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Mariela Ramon

LICENSING EVALUATOR NAME:

Barbara Beneroso

LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

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: HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER	FACILITY NUMBER: 157750004
	VISIT DATE: 11/01/2023

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

Health Related Services/IMS: This facility does not currently provide 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

Food Service: The facility currently is not participating in a food program. Children bring meals from home, LPA observed containers labeled with children’s name on it. Children eat Breakfast, Lunch and PM Snack at the center. There is currently no kitchen, there is however a refrigerator in the main office where children’s meals are kept, and a microwave located in the classroom.

Restrooms: LPA inspected and observed 2 restrooms, one toilet was not in operable condition. LPA observed toilet in the classroom to be clogged when trying to flush it. A type B Citation was issued for this violation. Per Site Director, children will use bathroom #2. LPA observed second bathroom to have soap, toilet paper and paper towels readily available. Water temperature is appropriate.

Napping: Children nap at the facility from 12:00pm – 2:00pm. LPA observed mats for each child properly stored. Bedding is washed weekly.

Outdoor: The facility one playgrounds/outdoor areas for the children. All outdoor and indoor passageways, stair ways, incline, ramps, open porches, and other areas of potential hazard are kept free of obstruction; Outside play area is completely fenced. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There is turf and concrete surface areas for active play. The area was observed to be free of debris, free from hazard, holes, broken items, debris, cushioning material underneath. No bodies of water were observed. There are areas for shade and rest. Facility provides water by refilling the children’s personal water bottles when taken outside. There are no pools or bodies of water in the facility.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

Page: 3 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: HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER	FACILITY NUMBER: 157750004
	VISIT DATE: 11/01/2023

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

Children/Personnel Records: Site Supervisor and Staff qualifications were verified. Children’s files were also observed to be complete.

Facility Records: Roster, sign in and out sheets and fire/disaster drill log (completed on 09/14/2023) were also observed to be maintained as required.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, earthquake preparedness checklist.

Lead Exceedance: Facility was not tested for Lead Exceedance, LPA offered Technical Assistance to file for an exemption since no water outlets are used food preparation or cooking.

Advisory/Other: The First Aid kits were observed in each classroom and were observed complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. CPR/First Aid expires on 01/07/2025. Mandated Reporter Training is maintained current, it expires on 03/28/2024. Electrical outlets are inaccessible, recalled and or prohibited toys or sleep/play equipment were not observed on the premises. There are no window cords accessible to children. No Smoking prohibited on the premises, daily inspection for illness, no prohibited childcare items observed. Firearms/weapons are not allowed or stored on premises.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

Page: 4 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: HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER	FACILITY NUMBER: 157750004
	VISIT DATE: 11/01/2023

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

Site Supervisor was advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the Child Care Center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm

Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

Page: 6 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: HELENA CHAVEZ EARLY CHILDHOOD EDUCATION CENTER	FACILITY NUMBER: 157750004
	VISIT DATE: 11/01/2023

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

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Site Supervisor shall permit the Department to inspect the Child Care Center, and to privately interview children or staff, to determine compliance with or to prevent violations of childcare center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

There was one Type B Citation issued during this visit. Exit interview conducted and report was reviewed with Site Supervisor, Sarah Bromiley. A copy of this report was provided electronically along with her appeal rights and Notice of Site Visit. A notice of site visit must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2023

LIC809 (FAS) - (06/04)

Page: 5 of 6