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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360902919
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:30:42 PM

Document Has Been Signed on 12/06/2023 03:30 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:PSD/SAN BERNARDINO PARK & REC HEAD STARTFACILITY NUMBER:
360902919
ADMINISTRATOR:LISA SIMMONSFACILITY TYPE:
850
ADDRESS:2969 FLORES STREETTELEPHONE:
(909) 887-3349
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 30TOTAL ENROLLED CHILDREN: 13CENSUS: 7DATE:
12/06/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:LaTrece Bright and Melissa RadjagukgukTIME COMPLETED:
03:35 PM
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On December 6, 2023, at 09:30 a.m., Licensing Program Analyst (LPA) Zirbes met with facility representatives, LaTrece Bright and Melissa Radjagukguk. The purpose of the inspection was to conduct an unannounced required three -year inspection. LPA disclosed the purpose of the inspection to the facility representatives. Present during today’s inspection were seven preschool age children, three teachers, and the management staff. The preschool program is operated out of two classrooms in the Parks and Recreational Community Center. The preschool program consists of two classroom, three children's restrooms, an outdoor space, main entrance area, staff offices spaces, staff lounge, staff restrooms and a kitchen. The kitchen space and staff restrooms are shared with the Community Center. At the time of this inspection only one classroom (40) was being utilized. The second classroom is currently used as a storage space. The facility currently operates Monday thru Friday 7:30am -4:30pm
Indoor/Children’s Area:
LPA and facility representative completed a tour at approximately 11:45 a.m. Child care center was observed to be clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean. Cleaning compounds were located in the following areas: in a high inaccessible area in the staff lounge, and in the kitchen. At the time of this inspection, all cleaning compounds were inaccessible. Zero poisons are stored in the licensed spaced. LPA observed the furniture/equipment is in good condition. Classrooms were free of flies, other insects, rodents. The classroom had tables and chairs to meet children’s needs. LPA observed the classroom had designated areas for dramatic play, art, writing, manipulates, library, computer area and a calming area. In addition, there was a carpet area for story/instructional time. Children's belongings are kept in cubbies labeled with the children's names. Trash cans for solid waste have tight fitting lids. Drinking water is readily available indoors via a water cooler and cups. All materials and surfaces are toxic free, window screens in good repair and free of debris. There is a carbon monoxide detector, smoke detector and Fire Extinguisher in the classrooms. Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PSD/SAN BERNARDINO PARK & REC HEAD START
FACILITY NUMBER: 360902919
VISIT DATE: 12/06/2023
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Report continued from page one

There was working telephone service within the Center. The facility has central heating and air conditioning and was a comfortable temperature at the time of this inspection. Smoking is prohibited on the premises. LPA did not observe prohibited childcare items during this inspection. Electrical outlets are inaccessible. Firearms/weapons are not allowed or stored on premises. There are zero bodies of water on the premises. Per conversation with the facility representative, staff conduct wellness checks each day on the students. An isolation area is located in teacher desk area.
Restrooms: The Center has a total of three children's restrooms. Classroom 40 has two children's restrooms each equipped with one toilet and one sink. The other classroom was equipped with one sink and one toilet. Restrooms were observed to be in safe and sanitary operating condition. Toilets and sinks are functioning properly and are age appropriate. The children's restrooms only deliver cold water. Paper towels and soap were available to the children.

Kitchen: The facility shared a kitchen with the Community Center. The kitchen is inaccessible to the children via closed door equipped with a chime. Kitchen has a sink, refrigerator, and oven. Two meals and one snack are provided to the children.
Napping: Mats are utilized and were observed to be in good condition.
Outdoor: The Center has a large shaded outdoor play area. The area has one large play structure, tricycles, balls, chalk. The large play structure had two slides. Rubber cushioning material was present under the play structure and the play structure was securely anchored to the ground. A fence surrounds the outdoor area that is at least 5 feet high. Water is available outdoors via a pitcher and cups brought out with the teacher. One drinking fountain was present in the outdoor space. The spout and basin of the functional drinking fountain was observed with dirt and dried leaves. Facility representative stated the children do not drink from this drinking fountain. Facility representative expressed the drinking fountain is normally covered to prevent the children from having access. LPA observed a torn cover and red tape at the base of the fountain. LPA advised the Center to either ensure the drinking fountain is clean, safe and sanitary or covered at all times when children are in care. An advisory notice was issued.

Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PSD/SAN BERNARDINO PARK & REC HEAD START
FACILITY NUMBER: 360902919
VISIT DATE: 12/06/2023
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Report continued from page two

Teacher child ratios were observed, and found to met the requirements. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
Health Related Services
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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
Child/Personnel Records
LPA reviewed five child records and four personnel files during this inspection. Per LPAs review child records were complete and contained all required information. The documents within the child files did not have the Palmdale Regional office listed. LPA provide the Center with a verbal notice to update the documents. One of four personnel records reviewed did not complete the Child Care Provider specific mandated reporter training, an advisory notice was issued. In addition one type B citation was issued for regulation 101212(b) Reporting Requirements. Per staff interviews, the Administrator on record, Lisa Simmons has not worked at the Center for the past two to three years. The Center failed to report the change of Director to the Department and failed to submit the required supportive documents. Refer to LIC 809D

Facility Records


LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility. LPA observed a current roster, disaster drill log (last drill completed in November 2023), sign in/out records. The Center had the required lead testing completed in 2.25.23. Per LPA review of the lead testing documents a drinking fountain located in the outdoor play space was not tested on 2.25.23. During LPAs walk through of the Center, the outdoor drinking fountain was accessible to the children and was in working condition. Facility Representative expressed this drinking fountain is not utilized by the preschool children and it is normally off limits via the use of a cover with the water turned off. At the time of the water testing this fountain was labeled "closed to be removed". LPA advised the Center that the outdoor drinking fountain had to be tested or removed, an advisory notice was issued. Report continued on page four
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PSD/SAN BERNARDINO PARK & REC HEAD START
FACILITY NUMBER: 360902919
VISIT DATE: 12/06/2023
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Report continued from page three

Posting Requirements
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393L), menu, car seat law (PUB 269), emergency disaster plan. LPA observed the address and phone number to the Los Angeles County Public Health Office was listed on the PUB 269 rather than the local San Bernardino office. LPA advised the Center to update the document with the local health department.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Director shall permit the Department to inspect the center, and to privately interview children or staff, to determine compliance with or to prevent violations of laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

Facility representative was advised of the requirement to report Unusual Incidents. Facility representative was informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address: unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report continued
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/06/2023 03:30 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 12/06/2023 at 02:31 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: PSD/SAN BERNARDINO PARK & REC HEAD START
FACILITY NUMBER: 360902919

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above when the Administrator on record, Lisa Simmons has not worked at the Center for the past two to three years. The Center failed to report the change of Director to the Department which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2023
Plan of Correction
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Per facility representative, a plan of correction will be submitted to the Department by 12/8/2023 to address the above deficiency.
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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PSD/SAN BERNARDINO PARK & REC HEAD START
FACILITY NUMBER: 360902919
VISIT DATE: 12/06/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Based on LPAs record review and observations one tyep B citation and three advisory notices were issued. Refer to LIC 809D.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility representative Melissa Radjagukguk.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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