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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810042
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:46:28 PM


Document Has Been Signed on 04/11/2024 12:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:SBCUSD-HILLSIDE PRESCHOOLFACILITY NUMBER:
364810042
ADMINISTRATOR:LATASHIA KELLYFACILITY TYPE:
850
ADDRESS:4975 MAYFIELD AVENUETELEPHONE:
(909) 730-3674
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:24CENSUS: 17DATE:
04/11/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Stephanie RoblesTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Lead Teacher, Stephanie Robles for the purpose of conducting a unannounced Annual/Random inspection. This is a State PS Program conducted on the grounds of Hillside Elementary School in a modular. The programs hours of operation: Monday - Friday from, 8:20 am 11:20 am and 12:20 pm to 3:20 pm in Rm PS#16. Preschool classroom has a separate exit and entrance from the elementary school.

LPA observed age appropriate furniture, equipment, toys and materials. The classroom was observed to be clean and safe and free of any Health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. Children's belongings are kept in cubbies along the wall as you enter classrooms. Drinking water is available inside the classroom in the form of a water fountain. Lead testing was conducted 1/24/23 was tested and were within limits.

**The children's bathrooms are located within the classroom two bathroom. Each bathroom has 1 toilet and 1 sink. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate. Staff restroom is located in the main building.
**Two half day programs, children do no not nap at this site. All flooring and carpets were inspected for cleanliness, and in good repair. Breakfast and Lunches are brought over daily from the school cafeteria.

Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes rubber matting under climbing structures for cushioning material. Large play equipment and climbing structures are securely anchored. The area was observed to be free of debris. Outside Drinking water is available in the form of a water fountain. There are no bodies of water observed on the premises. The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCUSD-HILLSIDE PRESCHOOL
FACILITY NUMBER: 364810042
VISIT DATE: 04/11/2024
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**The Parent Board located within the classrooms has contains required licensing forms. Staff are certified in Pediatric CPR and First Aid (exp 4/4/25). Children files reviewed today were complete including current/required immunization's. Center utilizes electronic sign in and out sheets. LPA observed a fully stocked first aid kit; fully charged fire extinguishers; carbon monoxide detectors throughout the center. Fire Drill/Earthquake log is posted. fire/disaster drill log last completed on 04/04/2024

Teacher- child ratios were observed and Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

Health-Related Services: The Lead teacher has been advised all prescription and non-prescription medications must have the child’s name and are dated, written consent and instruction from the child’s representative, and a plan to document and report to the child’s representative when medication is administered to a child; Medication will be properly labeled and stored in its original container. The IMS plan was discussed and The Lead Teacher understands when IMS is necessary

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 -

Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare 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.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCUSD-HILLSIDE PRESCHOOL
FACILITY NUMBER: 364810042
VISIT DATE: 04/11/2024
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The following was discussed with the Licensee:

Mandatory licensing forms for the children’s files, facility forms/records, and information to be posted; Requirements to conduct fire and disaster drills once every six months and record it; Role and responsibilities of being a mandated reporter (www.mandatedreporterca.com) were reviewed, to be completed every two years; Lead Teacher reminded that 100% supervision is required at all times to children in care; The "Notification of Parent's Rights" poster must be posted in an area of the home accessible to parents. Lead Teacher advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov.

Lead Teacher advised of the requirement to report Unusual Incidents. Lead Teacher 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.

The lead teacher advised that the Notice of Site Visit must be posted at the entrance of the facility for 30 days whenever a licensing inspection is conducted. If a Type A deficiency is cited, a copy of the licensing report must also be posted for 30 days. The same report must be provided to part obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from the parent/guardian & place it in each child's file. Copies of the reports must be provided to each parent when a Type A violation is cited along with Acknowledgment of Receipt of Licensing Reports LIC 9224. If these requirements are not met civil penalties per violation will be assessed.

Fingerprint clearances and transfers: Before working or volunteering in a licensed childcare 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 9184

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCUSD-HILLSIDE PRESCHOOL
FACILITY NUMBER: 364810042
VISIT DATE: 04/11/2024
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Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Licensee shall permit the Department to inspect the family childcare home and to privately interview children or staff, to determine compliance with or to prevent violations of family childcare 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.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

No deficiency. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm. An exit interview was conducted, and the report was reviewed with the Lead Teacher Stephanie Robles

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4