360904386-10-10-2024-12-CC-KZIS-D9WR34-20241010123918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 360904386
Report Date: 10/10/2024
Date Signed: 10/10/2024 12:39:28 PM

Document Has Been Signed on 10/10/2024 12:39 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:	LAKE ARROWHEAD COOPERATIVE PRESCHOOL		FACILITY NUMBER:	360904386
ADMINISTRATOR/ DIRECTOR:	JODY AUTEN		FACILITY TYPE:	850
ADDRESS:	351 N. STATE HIGHWAY 173		TELEPHONE:	(909) 313-0440
CITY:	LAKE ARROWHEAD	STATE: CA	ZIP CODE:	92352
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 9	CENSUS: 9	DATE:	10/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Facility Representative Jody Auten		TIME VISIT/ INSPECTION COMPLETED:	12:45 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 October 10, 2024, at 09:15 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Annual/Random Inspection and met with Administrator Jody Auten. LPA disclosed the purpose of the inspection and was granted entry into the facility by Administrator. Nine children, the Administrator and two parent volunteers were present during the inspection. Based on LPA observation, the center was meeting the staffing/ratio requirements. The facility is located on the grounds of Lake Arrowhead Community Presbyterian Church. The preschool program operates one of one classroom, located in the meeting room of the Church. The Center has one bathroom, a kitchen, gym and outdoor activity space. The current hours of operation: 9:00 a.m. to 12:00 p.m. Monday, Wednesday, Thursday, September through end of May. Indoor/Children's Area: At 09:40am the walk through was conducted. LPA observed Child care center was observed to be clean, 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 stored in an inaccessible shelf near the staff office, in the kitchen and in the staff office. LPA observed the indoor furniture/equipment was in good condition. Classroom was free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the Center had a variety of art supplies, manipulates, a library, dramatic play space and a circle time area. 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 children's water bottles. All materials and surfaces are toxic free, window screens in good repair and free of debris. LPA observed a carbon monoxide detector in the Center. Restrooms: The Center has one restroom with two toilets and one sink. Toilets and sinks were functioning properly and are age appropriate. The areas were clean and sanitary at the time of this inspection. Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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: LAKE ARROWHEAD COOPERATIVE PRESCHOOL	FACILITY NUMBER: 360904386
	VISIT DATE: 10/10/2024

NARRATIVE

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Report continued from page one

Meals: The parents provide one snack a day. Menus were posted in the front entranceway.

Napping: This is a half day program therefore the children do not nap at the Center.

Outdoor: LPA inspected the outdoor play space for health, safety, cushioning material, good repair and age appropriateness. The area had one large climbing structure and additional age appropriate materials for the children. The climbing structure was placed on wood chips and was secured to the ground. The outdoor play space is fully enclosed by a chain link fence. Water is accessible, via the children's water bottles. Per Administrator there are zero bodies of water on the premises.

Child/Personnel Records
LPA reviewed five child records, one staff record and four parent volunteer records. Based on LPA review, child files contained all required information. Based on LPA review, three of four parent volunteer records did not contain documentation of being immunized against pertussis and measles. Per Administrator all parents have the required immunization's, however the medical records have not been added to the files. A type B citation was issued, as this is a potential risk to the children in care.

Facility Records

LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.

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. Report continued on page three

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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: LAKE ARROWHEAD COOPERATIVE PRESCHOOL	FACILITY NUMBER: 360904386
	VISIT DATE: 10/10/2024

NARRATIVE

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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.

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 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.

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.

As a result of this inspection,one type B citation was issued.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Jody Auten. Appeal rights were provided.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/10/2024 12:39 PM - It Cannot Be Edited

Created By: Kendal Zirbes On 10/10/2024 at 11:07 AM

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: LAKE ARROWHEAD COOPERATIVE PRESCHOOL	FACILITY NUMBER: 360904386
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(c)

The day care center shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the day care center. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in three of four parent volunteer records did not contain documentation of being immunized against pertussis and measles, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2024
	Plan of Correction
1 2 3 4	Per facility representative, proof of the required immunizations will be added to the files. Proof of correction will be submitted to the Department.

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:

Lady King

LICENSING EVALUATOR NAME:

Kendal Zirbes

LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

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