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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416078
Report Date: 08/20/2025
Date Signed: 08/20/2025 02:01:17 PM

Document Has Been Signed on 08/20/2025 02:01 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/
DIRECTOR:		FOUNTAIN, KELLYFACILITY TYPE:
850
ADDRESS:835 EAST AVENUE K-4TELEPHONE:
(661) 948-6152
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 16DATE:
08/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Erica Robinson, Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On August 20, 2025, at 8:40 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo met with the Lead Teacher, Erica Robinson (staff 1) to conduct an unannounced annual inspection for the preschool license in accordance with the facility sketch. A tour of the facility was conducted. LPA observed a total of 16 preschool children in one classroom (Room 20) with 3 staff providing care and supervision. The center has two sessions The center has two sessions and operates Monday through Friday, from 8:00 A.M. - 11:00 A.M. for the first session, and 12:30 P.M. to 3:30 P.M. for the second session. Licensing fees are due on October 8, 2025.

Indoor/Children’s Area:
The room is clean, safe, sanitary and in good repair; the entrance and exit doors of the classroom is kept free of obstructions; floors of the room have a surface that is safe and clean, spray bottles disinfectants are used to sanitize rooms, furniture/equipment is in good condition and is free of flies, other insects, and 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 storage space (cubby, individually labelled with name) for his/her clothing, personal belongings. There is a working telephone. Electrical outlets are inaccessible and have plastic safety plugs. Recalled and or prohibited toys or sleep/play equipment were not observed on the premises. There are no window cords accessible to children.

At 9:00 A.M., fire and earthquake drills were conducted. LPA observed the staff used ropes with donuts (circles) attached to the rope.

Trash bins for solid waste have tight fitting lids. Per staff 1, they have maintenance and cleaning personnel
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2025
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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Document Has Been Signed on 08/20/2025 02:01 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 08/20/2025 at 01:31 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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide staff #3 Pertussis and Measles vaccination which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 09/05/2025
Plan of Correction
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The Early Learning Administrator will email a copy of staff #3 Pertussis and Measles vaccination to LPA.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the facility did not comply with the section cited above by failing to provide the staff’s current pediatric CPR/First Aid training which posed a potential Health, Safety or Personal Rights risk to persons in care.
POC Due Date: 09/05/2025
Plan of Correction
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The Early Learning Administrator will email a copy of the staff pediatric CPR/First Aid training certificate to LPA.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lady King
NAME OF LICENSING PROGRAM MANAGER:
Joselito DelMundo
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2025


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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 08/20/2025
NARRATIVE
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that come after the afternoon session. Water dispenser is available in the classroom. All materials and surfaces are toxic free. There is no fireplace in the facility. The center has an internal pull-down fire alarm system and fire extinguisher, and it has a 2-A:10-B:C type of fire extinguisher. Carbon monoxide devices are in operable condition (tested at 9:44 A.M.).

Restrooms: LPA inspected and observed one toilet and one sink inside the classroom. LPA also observed liquid soap, paper towel, toilet paper, and height measuring equipment. LPA also observed 1 sink with water fountain outside of the bathroom. Water temperature is appropriate. There is an isolation area for children who become ill while in care and children sit on little couches. Children who are ill are also accompanied by the staff and were taken to the Nurse Office. The facility maintains a comfortable temperature at all times, first aid supplies (first aid manual/guide, bandages, scissors, tweezers), electronic sign in/out sheets available and completed daily. Smoking is prohibited on the premises, daily inspection for illness, no prohibited child care items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.



Per staff 1, children do not nap inside the classroom. No sleeping mats/cots were observed during this inspection.

Outdoor: The facility has one playground area for preschool children. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. The area was observed to be free of debris, free from hazard, holes, broken items, debris. Drinking water is provided using water jug. Children also bring their own bottle water. Play equipment has rubber cushioning material. No bodies of water were observed.

Teacher child ratios were observed, and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.



Health Related Services: According to staff 1, the lead teacher is the only designated personnel to administer prescription medications with the parents’ consent and document the dosages, date, and the time the medications were recorded.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 08/20/2025
NARRATIVE
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Staff 1 stated that they were not providing transportation to children in care.

Children are inspected for illnesses (wellness policy) as they arrive. Teachers visually check and observe children when they arrive at the facility. Per staff, at this time, no medications are provided to the preschool children. If medications are administered, they would be provided only with parent's written permission and a doctor's note. Staff document when the medication is administered. The staff was advised that the medication must be properly labeled and stored in its original container. All medications are stored in a locked cabinet within the staff bathroom.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

Food Service: The facility has monthly menu posted on the parent board. The center provides breakfast for the morning session and lunch for the afternoon session.

Staff/Personnel Records: Designation of Responsibility observed, immunizations, TB clearance (for staff 1 and 2), health screening, criminal record statement, statement acknowledging requirement to report suspected child abuse, and mandated reporter were reviewed and observed on file. Staff #1 and #3 took the CPR and First Aid training online and staff #2 has expired CPR and First Aid training dated July 14, 2023. The staff were advised to take the in-person CPR/First Aid training either through the American Red Cross, American Heart Association, or any Emergency Medical Services Authority (EMSA) approved/accredited training centers. Staff #3 do not have Pertussis and Measles vaccinations on file.



Facility Records: Electronic Roster, fire/disaster drills log was completed today, August 20, 2025, at 9:00 A.M.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 08/20/2025
NARRATIVE
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penalty. The following were observed and posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), emergency disaster plan, earthquake preparedness checklist, and California Car Seat Law.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available.

According to staff 1, parents use electronic Sign in and out sheets when dropping off and picking up their child. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills conducted today, August 20, 2025. The facility has a daily schedule posted inside the classroom.

The staff 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 family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.



The staff 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Administrator shall permit the Department to inspect the family child care home, and to privately interview children or staff, to determine compliance with or to prevent violations of child care 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.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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: LANCASTER-JACK NORTHROP ELEMENTARY STATE PRESCHOOL
FACILITY NUMBER: 197416078
VISIT DATE: 08/20/2025
NARRATIVE
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process

Type B deficiencies were cited during this inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The On 8Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.



Exit interview conducted and a copy of this report, Notice of Site Visit, and appeal rights were provided to Early Learning Administrator, Donald Bakeer.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Joselito DelMundo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC809 (FAS) - (06/04)
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