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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416078
Report Date: 04/13/2023
Date Signed: 04/13/2023 12:26:23 PM

Document Has Been Signed on 04/13/2023 12:26 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:LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
197416078
ADMINISTRATOR:FOUNTAIN, KELLYFACILITY TYPE:
850
ADDRESS:835 EAST AVENUE K-4TELEPHONE:
(661) 948-6152
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 18DATE:
04/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Lead Teacher, Christina BaldwinTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA), Donna Maddox met with the Lead Teacher, Christina Baldwin today for the purpose of conducting and unannounced Annual inspection. This Preschool is located on the campus. at Jack Northrop Elementary School in Room #20. Present today were 18 children, 3 Teachers. The center has two sessions and operates Monday through Friday from 8:00 AM - 11:00 AM for the first session and 12:30 PM to 3:30 PM for the second session. This facility has an approved waiver on file for the shared use of the yard.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of a water cooler and disposable cups.

There is a bathroom located within the classroom that has 1 toilet and 1 sink. An additional bathroom is available outside of the classroom and contains 5 toilets and 2 sinks. Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available. Water temperature was tested and is appropriate.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 04/13/2023
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Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. Large play equipment and structures are securely anchored. Yard uses rubber cushioning under the large play structure and swing areas. The area was observed to be free of debris. There is an area for shade and rest. Drinking water is available in the form of water fountains (LPA has contacted Kelly Fountain regarding water testing). Play area was inspected for hazards and inaccessibility to bodies of water

*The play area contains a bicycle path and there is a separate storage area for play equipment. The yard is shared with the Elementary school's 3 kindergarten classrooms. The play area is enclosed by a fence. There is an outside play schedule which prevents preschool children and kindergarten children from commingling.

*Children are inspected for illnesses as they arrive. A review of medication policy indicated that only prescription medication is administered and only with parent's written permission. The main office will review the medication consent forms and train staff on its administration. The lead teacher will usually be designated to administer the medications and document the dosages, dates, and time administered onto a log. Medication is properly labeled and stored in its original container. There is a separate area for isolation and care of ill children in a corner of the class. There is a mat available for each ill child. The children's bathroom is used during isolation and is sanitized after its use by ill children.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 04/13/2023
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*The school's cafeteria prepares all snacks and delivers to the classroom (center serves snacks only). Menus are posted.
*Teacher child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
*Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Children's records were reviewed at the facility and observed to be complete.

*Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm - Director states there are no children present whom require IMS, but there is a plan in place.

*Type B citation issued today for the carpet in the classroom. LPA observed the carpet is in need of shampooing and there are areas of the carpet that are buckling which could cause a tripping hazard to children in care. Also, LPA observed a can of disinfectant under the sink in a cabinet that was not locked. Exit interview conducted, copy of report left with Director.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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Document Has Been Signed on 04/13/2023 12:26 PM - It Cannot Be Edited


Created By: Donna Maddox On 04/13/2023 at 11:40 AM
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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.3(b)
Indoor Activity Space
(b) The floors of all rooms shall have a surface that is safe and clean.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the facility did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/20/2023
Plan of Correction
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LPA will contact ECE coordinator for a POC
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the facility did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. LPA observed a can of disinfectant in the cabinet under the sink
POC Due Date: 04/14/2023
Plan of Correction
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Staff placed a safety latch on this cabinet the disinfectant is now inaccessible to children,
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:Lady King
LICENSING EVALUATOR NAME:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2023


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