263801648-12-3-2025-12-CC-CALI-DNZTHN-20251203134500

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 263801648
Report Date: 12/03/2025
Date Signed: 12/03/2025 01:45:33 PM

Document Has Been Signed on 12/03/2025 01:45 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	IMACA COLEVILLE PRESCHOOL		FACILITY NUMBER:	263801648
ADMINISTRATOR/ DIRECTOR:	TAMMY NGUYEN		FACILITY TYPE:	850
ADDRESS:	111527 HIGHWAY 395		TELEPHONE:	(760) 873-3001
CITY:	COLEVILLE	STATE: CA	ZIP CODE:	96107
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 16	CENSUS: 7	DATE:	12/03/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:40 AM
MET WITH:	Kristina Beaumont, Teacher		TIME VISIT/ INSPECTION COMPLETED:	01:50 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 12/3/25, Licensing Program Analyst (LPA) Crystal Ali arrived at the facility to conduct an Annual Random Inspection. LPA was met by Site Supervisor Kristina Beaumont and permitted to enter the facility. LPA toured the facility in accordance with the facility sketch with Site Supervisor. During the inspection, LPA observed 7 children and 2 staff (teacher and aide) providing care and supervision. LPA met the SLPA Director visiting for services for a child. Facility operates Monday through Friday from 7:45am to 2:15pm. Staffing Ration and Capacity: Facility consists of one classroom, one office (off-limits safety gate), one kitchenette (off-limits locked door), one children’s bathroom, and one 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.Physical Plant: 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. The children have access to water via individual water bottles and the water fountain on the playground. Smoke and carbon monoxide detectors are operating according to Fire Marshall standards. First Aid Kits (2) at the front door are incompliance. Trash cans with tight-fitted lids were observed.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

NARRATIVE

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Napping: Children are provided napping time. Children bring their own napping materials. The facility provides the napping ats and sanitizing them each day. Children take their napping materials home every Friday to wash. They do provide a calming/resting area for children, if needed.
Kitchen: The kitchenette is off-limits. The kitchen is equipped with a refrigerator, freezer, air fryer, toaster, and microwave oven. The facility provides morning and afternoon snack. Allergy lists are posted in the kitchen and in the child file. LPA observed an appropriate amount of food and snacks prepared with gloves. The chemicals are kept separate from the food in locked wooden cabinet inaccessible to children. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. The knives are on top of the refrigerator in a drawer. in the LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Snack menus are posted at least one week in advance and made available for review by the parents. The facility does not participate in the food program. Daily activity schedules are posted showing meal/snack times, and specific activities. Food allergies are noted and are posted in the kitchen on the refrigerator. There is one child with food allergies posted. There is outside food allowed as children bring their own packed lunches. Lunchboxes have ice packs, those without ice packs will be placed in refrigerator with child name on it.
Fire Extinguisher: Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 11/5/25 at 10am. LPA observed the fire extinguisher is not reading in green and does not meet the Fire Marshal Codes and Standards. The expired fire extinguisher is located at the front door of the classroom. Site supervisor states they will replace the fire extinguisher immediately. During visits, LPA observed the new fire extinguisher and took photo. Fire extinguisher is reading in the green last serviced 6/15/25.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

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Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets (1) flushed properly; and sink (1) located outside the bathroom to the left are reachable by the children. The bathroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff. Staff bathroom is clean and has 5 cabinets. All 5 cabinets are attached to the wall with safety latches.
Medication: A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The facility teachers are able to pass out medication. Medication is labeled correctly and stored in its original container. Medication is kept in the classroom in locked cabinet until expiration and sent home with the parent for disposal. There are currently no children on medication. There are currently no children in care with IMS needs. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. Isolation area is towards the back of the classroom near kitchen door where a teacher/aide will remain with the child until the parent comes.
Transportation: School does not provide transportation for the preschool children.
Lead Testing/Drinking Water: LPA checked file and online database prior to today and was unable to find records. LPA requested records from superintendent on 11/26/25. LPA received the documentation during this inspection. Lead water testing completed 9/24/23, no concerns.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

NARRATIVE

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Outdoor Activity Space: The outdoor play area was inspected. The children and staff walk to their play area on the basketball court. They have to walk around the gym and near a shed. The area near the shed has an old fence and tumble weeds. The walking path is cleared of derby. Staff must provide 100% supervision when outside in the playground. Children are provided water via individual drinking bottles or the two water bubblers during outdoor play. There is adequate shaded area for rest. The playground is well-fenced and no bodies of water were observed in the outdoor play area. LPA observed outside play time is 20 minutes due to the current weather.
Records/Documentation: LPA reviewed with facility representative the LIC 126, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Children records are incompliance. Employee records are not incompliance. Aide does not meet the qualifications of a teachers aide and is missing MMR vaccination. Site supervisor states that the aide is enrolled in health and safety training and has some experience working with children volunteering at a school.

No deficiencies cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

A notice of site visit was given and must remain posted for 30 days. A copy of this report and copy of appeal rights were provided to site supervisor.

Exit interview conducted and report was reviewed with the Site Supervisor, Kristina Beaumont.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Criminal Record Clearance - Child Care Centers
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.
Lead Testing – Child Care Centers (CCC)
CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:
Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care
Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

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Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility representative
of the importance of checking for recalled infant devices on the United States
Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Incidental Medical Services (IMS) - Child Care Centers
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/. PIN 22-05-CCP
MyChildCarePlan.org – 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.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: IMACA COLEVILLE PRESCHOOL	FACILITY NUMBER: 263801648
	VISIT DATE: 12/03/2025

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Subscribe to CCLD important information - Child Care Centers
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Crystal Ali
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025

LIC809 (FAS) - (06/04)

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