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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801923
Report Date: 10/17/2025
Date Signed: 10/17/2025 01:34:30 PM

Document Has Been Signed on 10/17/2025 01:34 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:SBCSS SIEGRIST STATE PRESCHOOLFACILITY NUMBER:
364801923
ADMINISTRATOR/
DIRECTOR:		NANCY CRUZFACILITY TYPE:
850
ADDRESS:15922 WILLOW STREETTELEPHONE:
(760) 244-6225
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 7DATE:
10/17/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:33 AM
MET WITH:Rosemarie Dunn - Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On Friday October 17, 2025, at 10:33 am, Licensing Program Analyst (LPA) Giovanni Cristales met with Lead Teacher, Rosie Dunn for the purpose of conducting an Annual/Random inspection for the day care classroom with a capacity of 32 children. The State Preschool operates on the grounds of Siegrist Elementary School. Upon arrival, in the morning program, LPA observed seven (7) pre-school children, and three (3) staff members. In the afternoon program LPA observed three (3) pre-school children. The Preschool is fenced off and separated from Elementary school children. The classroom operates in two half day programs from 7:30am - 3:30pm, Monday - Friday.

Indoor/Children’s Area:
The childcare center was toured and found to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children, employees, and visitors; All outdoor and indoor passageways, open areas of potential hazard are kept free of obstruction; heating, lighting, and ventilation are adequate, proper room temperature; floors of all rooms have a surface that is safe and clean, (cleaning compounds, chemicals, poisons locked inside the office), furniture/equipment are in good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent storage space (cubby, individually labelled with name) for his/her clothing, personal belongings. Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors. There is working telephone service on the premises. There is an isolation area for children who become ill while in care located in the office room.

Bathroom: LPA inspected and observed the bathroom located inside the classroom (bathroom contained 1 toilet and 1 sink). Toilets and sinks function properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2025
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: SBCSS SIEGRIST STATE PRESCHOOL
FACILITY NUMBER: 364801923
VISIT DATE: 10/17/2025
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Food Service: Snacks are supplied by Rene Hope foundation. The facility has a clean refrigerator located in the office room. The teachers bring out the snacks from the office and provide them to each child in the classroom. Menu items are posted in each classroom. LPA observed today’s menu, mixed fruit cup, 4oz., goldfish crackers, ½ serving and water.

Outdoor play: Equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes sand under climbing structures. There are also concrete and grass surfaces for proper playing. There is a Canopy structure and tree, providing sufficient and adequate shade. Large play equipment and climbing structures are securely anchored (swing set and 1 large climbing structure). The area was observed to be free of debris. Outside drinking water is available in the form of drinking fountain. Sandboxes are raked and inspected daily and kept free of hazardous foreign materials. There are no bodies of water observed on the premises. The entire playground is enclosed to protect children and to keep them in the outdoor activity area.

Other: Fire/earthquake drills are current (10/02/2025). There is a fire extinguisher (2A10BC) located at the entrance (last served 8/11/2025), smoke detectors, and carbon monoxide detectors in each classroom. First Aid Kit (Red backpack located at the entrance) is full and accessible (thermometer, bandages, scissors). LPA observed LIC 9275, External Water Sampler Self-Certification Form (10/28/22), Sample Description - A-CF-P Classroom C Faucet, Analyte(s) - Metals and Metalloids, Result - ND, RDL - 1.0, Units - ug/L, Method - EPA 200.8.



Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The parent board was reviewed and has all the required forms posted. The following were observed posted as required: Facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393L), menus, car seat law (PUB 269), emergency disaster plan, earthquake preparedness checklist.

Staff/Personnel Records: Staff file review reveals staff are qualified for their perspective positions. LPA reviewed three (3) staff files, and two (2) children files. Immunization's, CPR/First Aid, TB clearance, health screening, criminal record statement, statement acknowledging suspected child abuse, mandated reporter, and employee rights were observed in each staff’s file. CPR/First Aid, Staff #1 Expires: 4/12/2027, and Mandated Reporter Expires: 09/22/2027. For additional staff, see LIC 859. Children's files (digital) contained required forms and documents, see LIC 857.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
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: SBCSS SIEGRIST STATE PRESCHOOL
FACILITY NUMBER: 364801923
VISIT DATE: 10/17/2025
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Health Related Services: This facility provides Incidental Medical Services – IMS. A review of medication policy indicated that prescription medication is administered only with parent's written permission and or doctor prescription; a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).

LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Staff administers medication and documents the dosage, date and time onto a log. Medication is brought and locked in the office. All medications, prescription and non-prescription have a child’s name and dated, properly labeled and stored in its original container.

The following general information was discussed during this inspection:

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.

On January 1, 2018, or before March 30, 2018, a person who is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the online mandated reporter training and shall complete renewal mandated reporter training every two years at www.mandatedreporterca.com.

Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.



*All Licensing reports are available for review on-line and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code, to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.
NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCSS SIEGRIST STATE PRESCHOOL
FACILITY NUMBER: 364801923
VISIT DATE: 10/17/2025
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Fingerprint clearances and transfers: Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state licensed facility to another using form LIC 9182.

Lead Teacher was advised of the requirement to report Unusual Incidents. Licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.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 the daycare center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm.

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 family child care home and to privately interview children or staff, to determine compliance with or to prevent violations of child care center 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.

A survey will be sent to the email address provided to improve the quality and value of the new inspection process. 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

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. No deficiency was cited today.

An exit interview was conducted, and the report was reviewed with the Lead Teacher Rosie Dunn.

NAME OF LICENSING PROGRAM MANAGER: Claretta Yates
NAME OF LICENSING PROGRAM ANALYST: Giovanni Cristales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
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