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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750042
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:50:01 PM

Document Has Been Signed on 04/09/2024 03:50 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 PRESCHOOLFACILITY NUMBER:
197750042
ADMINISTRATOR/
DIRECTOR:		CULPEPPER, DEBERAEFACILITY TYPE:
850
ADDRESS:44339 BEECH AVETELEPHONE:
(661) 579-2970
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 108TOTAL ENROLLED CHILDREN: 108CENSUS: 25DATE:
04/09/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Director Shannon AlfordTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 4/9/2024 at 8:35am, 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 Director Colleen Calloway guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 25 children and 7 staff providing care and supervision. Facility operates Monday through Friday from 7:30am to 4:30pm.

Facility consists of a total of 10 rooms/areas: four classrooms, one office, one kitchen, one staff restroom, two children’s restroom, and two outdoor play areas. ***WAIVER: There is a waiver on file for the second outdoor play area, the use of the second play area grass area only which does not include the climbing structure and swings as they are not age-appropriate; the Director attests that the preschoolers do not use the climbing structure or swings, only the grass area.

Indoor Activity Space:
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. At 9:14am, LPA observed sign-in sheets were not completed by each parent/guardian per requirements as there were only 3 of the 12 signatures required of that classroom, this is a Type B violation, see the LIC 809D for the details. LPA observed individual storage for children's belongings. Children are provided water via individual, disposable water bottles. An isolation area was inspected in the director’s office and located near a separate restroom. The calming area was inspected and located on the rug in the classrooms. Children are provided napping and age appropriate and individual bedding were observed; the facility has 45 mats; however, LPA explained that the mats should be up to capacity, technical assistance was provided. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed properly; toilet and sinks are reachable by the children; however, there are three standard sized toilets in the girls restroom and one in the boys restroom which require a stool
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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: LIFE SOURCE PRESCHOOL
FACILITY NUMBER: 197750042
VISIT DATE: 04/09/2024
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 technical assistance was provided. Each restroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff.

The facility has a dual smoke and carbon monoxide detector system and it was found operating according to Fire Marshall Standards at 9:35am. At 9:20am, LPA observed the fire extinguishers were not serviced in over a year, since 9/22/2022 for the facility and 9/2021 for an unused classroom, the Director stated that there is one that was tested on 2/2023; however, there has not been any tested within the last year which is a Type A violation of the fire clearance, see the LIC 809D for the details. The Director immediately corrected the Type A violation by acquiring two fire extinguishers from their secondary site and placing them in the facility per Title 22 Regulations. 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 storage room in the cafeteria or stored on top of tall cabinets/shelves in the classrooms. Medication is stored in the locked Office Manager’s Office which also has a refrigerator for refrigerated medication needs. The facility does not provide transportation. There is no smoking on the premises. At 10:38am, the LPA observed there is an armed security guard as a part of the school and on the premises with the preschool. The Director states that the children have limited contact with the security guard and that guard’s weapon is secured with a “Safari Land” Level 3 Retention Holder to prevent the weapon from being taken away accidentally out of the holster, technical assistance was provided.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 3/25/2024 at 9:30am for the drills. The fire extinguishers are a (3A40BC) and was last serviced on 9/22/2022 in most areas, and 9/2021 in an unused classroom. Menus are not posted at least a week in advanced, dated, and in sight of parents to review; although, the facility does have the menu, it was not posted, this is a technical violation. Daily activity schedules are posted showing meal/snack times, nap time, and specific activities. The parent board was reviewed and is missing the following required postings: LIC 610, LIC 9148, LIC 515, technical assistance was provided. Food allergies are noted and are documented in the kitchen and classrooms. There is no outside food allowed. The center provides meals: breakfast, lunch, and snacks.

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

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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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 PRESCHOOL
FACILITY NUMBER: 197750042
VISIT DATE: 04/09/2024
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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 water via individual, disposable water 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. The Preschool has a Waiver on file for the use of the second playground to meet capacity regulations.

Facility maintains an adequate teacher-child ratio; technical assistance was provided on observing the ratios and ensuring there is at least one teacher and an aide whenever there are over 12 children present in a classroom as there was one teacher to 13 children in Room 17 for approximately 2-3 minutes. 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, LIC 627- Consent for Medical Treatment, LIC 613A- Personal rights, LIC 995- Parent’s Rights, 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 is currently certified in Pediatric CPR/First Aid, expiring 2/2026. Child Care Providers (AB1207) Mandated Reporter training certificate is expiring in 2024 for most teachers; however, Staff 5 has not completed their training, this is a Type B violation, see the LIC 809D for the details. Personnel records included the LIC 9052- Employee Rights, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse; however, the immunizations for Staff 2 are incomplete and all are missing for Staff 5, this is a technical violation, the Director will ensure that all staff’s records have been reviewed and acquire any missing documentation per Title 22 Regulations. At 1:14pm, LPA observed that the qualifications for Staff 3 makes them a Teacher Assistant and should not be without a fully qualified teacher in the classroom; however, Staff 3 was in the classroom as a fully qualified teacher, this is a Type B violation, see the LIC 809D for the details.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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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 PRESCHOOL
FACILITY NUMBER: 197750042
VISIT DATE: 04/09/2024
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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/.

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.

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

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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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 PRESCHOOL
FACILITY NUMBER: 197750042
VISIT DATE: 04/09/2024
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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, one Type A and four Type B deficiencies have been cited. Please, see the LIC 809D for the citations. As a Type A deficiency has been cited, a copy of the citation and licensing report must be posted for 30 days. The same report must be provided to Parents/Guardians and the Acknowledgment of Receipt of Licensing Reports LIC 9224 must be signed by Parents/Guardians of all enrolled children and any newly enrolled children in the next 12 months following the citation. If these requirements are not met, civil penalties per violation will be assessed.

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.

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

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/09/2024 03:50 PM - It Cannot Be Edited


Created By: Andrea Pittman On 04/09/2024 at 03:05 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: LIFE SOURCE PRESCHOOL
FACILITY NUMBER: 197750042

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101171(a)
101171 Fire Clearance
(a) All child care centers shall... maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by the facility not having any fire extinguishers on site that have been timely serviced within the last year for the fire clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/10/2024
Plan of Correction
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Deficiency corrected during visit: the Director picked up two fire extinguishers that have been serviced within the last year from their secondary location which does not negatively impact the secondary location and brought them to the facility to cover per Title 22 Regulations.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024


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Document Has Been Signed on 04/09/2024 03:50 PM - It Cannot Be Edited


Created By: Andrea Pittman On 04/09/2024 at 03:14 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: LIFE SOURCE PRESCHOOL
FACILITY NUMBER: 197750042

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024

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
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 5 complete their Mandated Reporter Training within 90 days of hire which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/23/2024
Plan of Correction
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2
3
4
The Director will e-mail proof of completion of the Mandated Reporter Training Certificate for Staff 5 no later than 4/23/2024.
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
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having Staff 4 and 5 complete the LIC 503 Health Screening or similar within 7 days after employment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/09/2024
Plan of Correction
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The Director will e-mail proof of the completed LIC 503 Health Screening or similar document for Staff 4 and 5 no later than 5/9/2024.
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
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024


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Document Has Been Signed on 04/09/2024 03:50 PM - It Cannot Be Edited


Created By: Andrea Pittman On 04/09/2024 at 03:14 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: LIFE SOURCE PRESCHOOL
FACILITY NUMBER: 197750042

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(b)(1)
Teacher Qualifications and Duties
(b) Prior to employment, a teacher shall meet the requirements of (b)(1) or (b)(2) below: (1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below; or shall have obtained a Child Development Assistant Permit issued by the California Commission on Teacher Credentialing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by not having a fully qualified teacher in the classroom with Staff 3 as they can only be a Teacher Assistant which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/23/2024
Plan of Correction
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4
The Director will submit the request for an exception for the teacher and will submit a copy of the agenda for the meeting for changing the teacher's capacity no later than 4/23/2024
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above by having only 3 of the required 12 parent/representative signatures on the sign-in sheet in a classroom which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/23/2024
Plan of Correction
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2
3
4
The Director will email a copy of the agenda for the training on completing sign-in sheets per Title 22 Regulations no later than 4/23/2024.
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
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024


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