<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360900458
Report Date: 05/26/2023
Date Signed: 05/26/2023 12:26:08 PM

Document Has Been Signed on 05/26/2023 12:26 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:HESPERIA COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
360900458
ADMINISTRATOR:JACQUELYN MANSFIELDFACILITY TYPE:
850
ADDRESS:16775 OLIVE STREETTELEPHONE:
(760) 244-6164
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 67TOTAL ENROLLED CHILDREN: 67CENSUS: 0DATE:
05/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Jacquelyn Mansfield, DirectorTIME COMPLETED:
12:30 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 May 26, 2023, Licensing Program Analyst (LPA) Kuliema Calloway met with S1 for the purpose of conducting a Random Annual inspection. LPA toured and inspected the preschool in accordance with the facility sketch. LPA observed zero children upon arrival (school out until summer begins). Teachers present (meeting purposes only) with the director. Currently center is utilizing rooms # 20, 21, 22, and 42. Classroom #43 (summer only) Rooms 20, 21, and 23 are currently under construction and will be used for 3-4 yr. old’s. The center operates 6:00am - 6:00pm, Monday through Friday. Incidental Medical Services (IMS) policy was discussed. No children currently requiring IMS.
Furniture and equipment were inspected 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. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water pitchers and disposable cups and water fountain (at entrance). Children also bring their own water bottle. LPA observed mats available for napping children. The bedding is stored separately and properly. The sheets are provided by parents and sent home weekly (Friday) and returned on Monday. Mats are sanitized weekly (Friday). There is a fire extinguisher, smoke detector and a carbon monoxide detector on the premises. Parent board has the required documentation.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 05/26/2023
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
26
27
28
29
30
31
32
LPA inspected and observed two clean bathroom (2 toilets, 2 sinks). Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available. Seats are wiped with Clorox wipes after each use.

Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered at the facility only with doctor permission on the required center form. There is a separate area for isolation and care of ill children at Director office.



Outdoor play equipment was inspected for health, safety, cushioning material (sand), good repair and age appropriate. The play area has sand and concrete. The area was observed to be free of debris. There is an area for shade and rest. There is a water fountain. Play area (slide, climber, sand, cement, swings, shed with key lock, shade) was inspected and found to be free of hazards and inaccessibility to bodies of water. Separate play area (gated) for ages 2-3- and 4–5-year-old children. There are Little Tikes play equipment and a large swing set that anchored.

There is a small kitchen area used by staff located in room #21. Kitchen has a microwave and refrigerator/freezer. Chemicals (locked) and food are kept in separate cabinets. Center provides AM, PM snack and does not provide breakfast. Parents bring lunch for child and breakfast. Trash cans have a lid (tight fitting). Menus are posted in the classrooms and kitchen. Allergy lists are posted in kitchen and classroom. LPA observed small amount of food during the inspection. Children and staff records were reviewed. LPA verified there is at least 1 staff person present with current CPR and First Aid Training current and Mandated Reporter current until 8/2024
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 05/26/2023
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
26
27
28
29
30
31
32
Sign in and out sheets were reviewed. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current. Roster current. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate. Staff were questioned to establish their familiarity of emergency reporting requirements, emergency disaster plans and other site operations. Personal rights of children were discussed. First Aid Kit in each classroom.
Note: The CPR/First Aid training must be taken through American Red Cross, American Heart Association, or through Emergency Medical Services (EMS) Authority approved trainers. Online courses are not acceptable and would result in a citation.
Additional forms and a copy of Title 22 Regulations may be obtained at the department's website at: www.ccld.ca.gov.
--Director advised visit www.shotsforschool.org for Immunization information.
--Director was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640. Report Unusual Incident Reports on LIC 624B at unusualincidentsreports.ca.gov
--Child Care Centers (Disaster Planning information):https://cccld.childcarevideos.org/child-care-center-operators/disaster-planning-and-fire-safety/
--Child Care Videos: https://ccld.childcarevideos.org
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov.

Requirements for fingerprint clearances and associations were discussed with the Assistant Director.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 05/26/2023
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
26
27
28
29
30
31
32
--Quarterly Update: Before an individual can obtain a childcare license, or work in a licensed childcare facility, they must receive a criminal record clearance or exemption from the Department's Caregiver Background Check Bureau (CBCB).
--Assembly Bill 752, California's first law addressing suspension and expulsion in preschool. Visit the Preventing Suspension and Expulsion of Young Children in Child Care & Early Education site.
--AB 2370, Chapter 676, Statutes of 2018, mandates testing of water for lead in all childcare centers by January 1, 2020. Also provides for distributing educational materials and training on lead toxicity and prevention, as specified.
--AB 605, Chapter 574, Statues of 2018, calls for developing regulations necessary to implement a one center license structure to care for varying age groups by January 1, 2021.
--Department of Pesticide Regulation's (DRP) Integrated Germ Management Training Course is now available (visit our School and Child Care IPM Program page).
Incidental Medical Services (IMS) policy was discussed. 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 publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 05/26/2023
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
26
27
28
29
30
31
32
No deficiencies cited according to Title 22 Regulations. Consultation provided during the inspection.

Exit Interview conducted and a copy of report was read and a Notice of Site Visit was provided to Director, Jacquelyn Mansfield

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5