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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750023
Report Date: 11/13/2023
Date Signed: 11/13/2023 02:16:56 PM

Document Has Been Signed on 11/13/2023 02:16 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LAKE LOS ANGELES ELEMENTARY SCHOOLFACILITY NUMBER:
197750023
ADMINISTRATOR:LUNA, JESUSFACILITY TYPE:
850
ADDRESS:16310 EAST AVENUE QTELEPHONE:
(909) 633-9496
CITY:PALMDALESTATE: CAZIP CODE:
93591
CAPACITY: 24TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
11/13/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Melissa SouthwickTIME COMPLETED:
02:45 PM
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On 11/13/2023, Licensing Program Analyst (LPA) Carol Heath met with the lead teacher, Melissa Southwick and Assistant Superintendent of Instructional Services, Priya Darbari, to conduct an unannounced Annual/Random inspection. LPA disclosed the purpose of the inspection and was granted entry to the facility. The center has 1 classroom at the entrance on the right side of the elementary school hallway. There is a morning session (8:20 to 11:20 am) and an afternoon session (12:20 to 3:20 pm). Waivers are on file for shared outdoor play space and shared of indoor bathroom with the kindergarten class next door. There were 10 children present, the lead teacher and 3 assistants. Incidental Medical Services (IMS) were discussed.

Physical Plant: LPA toured and inspected the preschool classroom. Furniture and equipment were checked for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPA observed age-appropriate toys and materials. Daily activities schedule was observed in each classroom. Drinking water is available inside the classrooms in the form of disposable plastic cups and water jugs. A fire extinguisher (checked 6/11/2023), a smoke detector, and a carbon monoxide detector are on the premises.


All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; they shall be leakproof and rodent-proof.
The classroom has access to 2 bathrooms, which each contain 1 toilet and 1 sink. Staff bathrooms are in the administration office across the hallway.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LAKE LOS ANGELES ELEMENTARY SCHOOL
FACILITY NUMBER: 197750023
VISIT DATE: 11/13/2023
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 The toilets and sinks are functioning properly. There is soap, toilet paper, and paper towels readily available. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The Director and other administration staff administer medication and document the dosage, date, and time on a log. Medication is brought and locked at the center (unless the parent requests daily return). Medication is labeled correctly and stored in its original container. Medication is kept at the center until expiration and sent home with the parent for disposal. There are currently no children in care with IMS needs. The director's office has a separate area for isolating and caring for ill children. There is a mat available for ill children. An isolated toilet and sink are available for ill children in the staff restroom.
A Fire Drill/Earthquake log is posted in the main office. The center conducted disaster drills for monthly. A current Roster is available.
The outdoor: The play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. The outdoor play equipment was inspected for health, safety, cushioning material, good repair, and age appropriateness. The area was observed to be free of debris. The play yard is through a door in the back of the classroom. The 3–4-year-olds do not use the large play structures in the sand area. The 5-year-olds have access to the entire play yard. The locked shed on the playground contains age-appropriate toys. There's a shaded area for rest. There are no bodies of water on the premises. Water fountains are operable inside the classroom. LPA observed a first aid kit. LPA provided a First aid supplies list to the Director.
The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Sign-in and out sheets were reviewed. The Teacher-to-child ratio was observed, and staff names were recorded. Care and supervision were evaluated to determine if the children’s basic needs were met and appropriate.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LAKE LOS ANGELES ELEMENTARY SCHOOL
FACILITY NUMBER: 197750023
VISIT DATE: 11/13/2023
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Staff Records/Children's Records: Staff and children's records were reviewed. LPA verified there is at least 1 staff person present with current CPR and First Aid Training. All staff complete the Mandated Reporter training every 2 years. All staff receives Measles, Pertussis, and Influenza vaccination. All staff have requested fingerprinting associated with the facility.
LPA reviewed 5 children's records, complete with the parents' signatures.
Food Service: The facility provides breakfast for the am class and lunch for the pm class in the cafeteria down the hall on the left. Allergy lists are posted in the kitchen and classrooms. LPA observed an appropriate amount of food and snacks and staff preparing lunch (with gloves). The chemicals are kept separate from the food (kitchen adjacent to the kitchen sink or locked inaccessible in classroom cabinets). LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. Menus are posted at least one week in advance and made available for review by the parents.
Lead Water Testing: According to the Director, she is still determining if the center has Water testing for lead.
The following general information was discussed during this inspection:
· 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 the publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The Center does not provide IMS at this time.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LAKE LOS ANGELES ELEMENTARY SCHOOL
FACILITY NUMBER: 197750023
VISIT DATE: 11/13/2023
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· As of January 1, 2018, childcare providers, administrators, or employees who work in a licensed facility shall complete the mandated reporter training provided according to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
· §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare 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.
· All Licensing reports are available for review online and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.
· Before working or volunteering in a licensed childcare facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state-licensed facility to another using form LIC 9184
· Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of the report documenting a Type A Citation and sign form LIC 9224 acknowledging receipt. Staff is aware of the required forms for children's files and forms that shall be posted after licensure.
· Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LAKE LOS ANGELES ELEMENTARY SCHOOL
FACILITY NUMBER: 197750023
VISIT DATE: 11/13/2023
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· Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children.
· Center Director advised of the requirement to report unusual incidents and injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations and quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation about exemptions and Parent’s Rights was also discussed.

No deficiency was cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

Exit interview conducted and report was reviewed with the Assistant Superintendent of Instructional Services, Priya Darbari

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC809 (FAS) - (06/04)
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