197750032-4-8-2024-12-CC-APIN-D45TS4-20240408145832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197750032
Report Date: 04/08/2024
Date Signed: 04/08/2024 02:58:55 PM

Document Has Been Signed on 04/08/2024 02:58 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:	LIFE SOURCE PREPARATORY PRESCHOOL		FACILITY NUMBER:	197750032
ADMINISTRATOR:	CULPEPPER, DEBERAE		FACILITY TYPE:	850
ADDRESS:	44709 BEECH AVE		TELEPHONE:	(661) 789-7663
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	44	CENSUS: 28	DATE:	04/08/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Director Shannon Alford		TIME COMPLETED:	03:20 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 4/8/2024 at 8:40am, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Inspection. LPA was met by the Facility Representative and permitted to enter the facility. Director Shannon Alford guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 29 children and 9 staff providing care and supervision. Facility operates Monday through Friday from 6:00am to 6:00pm, serving ages 2 to 5 years old. Facility consists of a total of 10 rooms/areas: four classrooms, one office, one kitchen, one staff restroom, two 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, one-time use disposable cups. An isolation area was inspected in the front lobby and located near a separate staff restroom. The calming area was inspected and located in the rug area of the classrooms. Children are provided napping and age appropriate and individual bedding were observed; the facility has 44 mats. The LPA observed the facility to be free of vermin and other infestations. 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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: LIFE SOURCE PREPARATORY PRESCHOOL	FACILITY NUMBER: 197750032
	VISIT DATE: 04/08/2024

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Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition and are operating according to Fire Marshall standards. The facility's smoke and carbon monoxide detectors were found operating according to Fire Marshall Standards at 9:33am. LPA observed the first aid kit and it was found to be complete with the following supplies including tweezers, scissors, gauze, adhesive tape, 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 staff’s restroom.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 3/8/2024 at 9:02am for the drill. The fire extinguisher (3A40BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 11/15/2023); there are multiple fire extinguishers throughout the facility and one in each classroom. LPA observed at 10:09am that the menu for April 2024 was not yet posted and they are required to be posted a week in advance, LPA provided technical assistance and the Director printed and posted the menus at least a week in advanced, dated, and in sight of parents to review. Daily activity schedules are posted showing meal/snack times, nap times, and specific activities. The parent board was reviewed and are missing the following required postings: LIC 610, LIC 613A, LIC 9148, & PUB 515; LPA provided technical assistance and the missing forms; the Director posted them immediately. Food allergies are noted and are posted in the kitchen, in each classroom, and all staff are made aware of the allergies. There is store bought food permitted only from the parents. The center provides meals: breakfast, lunch, and snacks.

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 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.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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: LIFE SOURCE PREPARATORY PRESCHOOL	FACILITY NUMBER: 197750032
	VISIT DATE: 04/08/2024

NARRATIVE

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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; LIC 627 Consent for Medical Treatment, LIC 995- Parent’s Right, LIC 613A- Personal Rights, and Immunization Records are all in the children's file; however, the CDPH 286 is missing or incomplete from all records, this is a Type B violation, see the LIC 809D for details.

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 is currently certified in Pediatric CPR/First Aid, taken 2/21/2024 and expires 2/2026; the Director was made aware that there must always be someone present with a valid Pediatric CPR/First Aid Certification. Child Care Providers (AB1207) Mandated Reporter training certificate is valid and expiring for most staff in 2024-2025; however, the certification has expired for Staff 3, this is a Type B violation, see the LIC 809D for the details. The immunizations was missing: MMR & DTP for Staff 1, this is a technical violation, the Director was made aware to ensure all staff have their required immunizations prior to the start of employment.

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/.

Facility representative was informed of the MyChildCarePlan.org website; a

consumer education website that helps families obtain child care by connecting them to child
care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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: LIFE SOURCE PREPARATORY PRESCHOOL	FACILITY NUMBER: 197750032
	VISIT DATE: 04/08/2024

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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

A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations, this facility is not in compliance, three Type B Deficiency have been cited. Please, see the LIC 809D for the citations.

Exit interview conducted and report was reviewed with the Director Shannon Alford and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/08/2024 02:58 PM - It Cannot Be Edited

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: LIFE SOURCE PREPARATORY PRESCHOOL	FACILITY NUMBER: 197750032
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 3 renew their training when it expired which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/22/2024
	Plan of Correction
1 2 3 4	Director plans to e-mail proof of the Mandated Reporter Training for Staff 3 no later than 4/22/2024.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 1 and 2 complete the LIC 503 Health Screening prior to starting employment which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/08/2024
	Plan of Correction
1 2 3 4	Director plans to e-mail proof of the LIC 503 Health Screening to no later than 5/8/2024.

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	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/08/2024 02:58 PM - It Cannot Be Edited

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: LIFE SOURCE PREPARATORY PRESCHOOL	FACILITY NUMBER: 197750032
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not completing the PM-286 for the children not enrolled in school which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/22/2024
	Plan of Correction
1 2 3 4	Director will submit proof of completing the PM-286 for all the children not enrolled in school via e-mail no later than 4/22/2024

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	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC809 (FAS) - (06/04)

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