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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191223870
Report Date: 03/06/2024
Date Signed: 03/06/2024 02:07:46 PM

Document Has Been Signed on 03/06/2024 02:07 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:GRACE LUTHERAN SCHOOLFACILITY NUMBER:
191223870
ADMINISTRATOR:KAREN MARKINFACILITY TYPE:
850
ADDRESS:856 WEST NEWGROVE STREETTELEPHONE:
(661) 948-1018
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
03/06/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:PrincipalTIME COMPLETED:
02:30 PM
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On 3/6/2024 at 10:10am, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Inspection. LPA was met by Facility Representative and permitted to enter the facility. The Principal guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 17 children and 2 staff providing care and supervision. Facility operates Monday through Friday from 6:00am to 5:30pm.

Facility consists of a total of 6 rooms/areas: two classrooms, one office, one staff restroom, one children’s restroom, and one outdoor play area.

Indoor Activity Space:
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by each parent/guardian per requirements. LPA observed individual storage for children's belongings. Children are provided filtered water from a large container dispensed in individual water bottles and in individual, one-time use disposable cups. An isolation area was inspected and located near a separate restroom. The calming area was inspected and located in a corner of the classroom. Children are provided napping and age appropriate and individual bedding were observed; the facility has 25 cots. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff.

Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition and are operating according to Fire Marshall standards. LPA observed the first aid kit and it was found to be complete with the following supplies including tweezers, scissors, gauze, bandages, cleansing pad/solution, thermometer, and a first aid manual. Trash cans with tight lids were observed making solid wastes inaccessible to children in care. Cleaning supplies, hazardous materials, and/or poisons are found to be out of the reach of children and locked in the upper cabinets.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/06/2024
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Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 2/13/2024 at 8:30am for the drills. The fire extinguisher (3A10BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 2/2/2024). Menus are not posted as the facility does not provide meals, only am and pm snacks; children bring their meals from home. Daily activity schedules are posted showing meal/snack times, nap time, and specific activities. The parent board was reviewed and has all the required forms posted accessible to parents. Food allergies are noted and are posted on a white paper in each classroom. There is outside food permitted and the food is properly labeled.
Outdoor Activity Space:
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. LPA observed climbing structures and other play equipment were found to be securely anchored with adequate, resilient, cushioning material underneath and around the perimeter. Children are provided filtered water via a large container dispensed in disposable, one-time use cups and individual drinking bottles during outdoor play. There is adequate shaded area for rest. The playground is well-fenced, all around and no bodies of water were observed in the 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.

Records/Documentation:
Children's records were reviewed for completeness. LIC 702- Preadmission Health History, LIC 700- Identification & Emergency contact, and LIC 701- Physician Reports or similar documents used by the facility; Immunization Records and CDPH 286 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. Personnel records were reviewed for completeness. Director and teachers are currently certified in Pediatric CPR/First Aid, expiring in 2024. Child Care Providers (AB1207) Mandated Reporter training certificate is expiring in 2025.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/06/2024
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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.

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/.

All staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 years. 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. Applicants must meet requirements as a precondition to licensure. 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. Director is aware self and all staff 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.

For additional information and forms visit our website at: www.cdss.ca.gov


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 platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


For updates on Community Care Licensing, please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GRACE LUTHERAN SCHOOL
FACILITY NUMBER: 191223870
VISIT DATE: 03/06/2024
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A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations, this facility is in compliance, no deficiency will be issued today. Exit interview conducted and report was reviewed with the Principal and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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