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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364812086
Report Date: 10/07/2022
Date Signed: 10/07/2022 12:40:17 PM

Document Has Been Signed on 10/07/2022 12:40 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:SJUSD-PHELAN ELEMENTARY SCHOOL STATE PRESCHOOLFACILITY NUMBER:
364812086
ADMINISTRATOR:BRENDA NOPWASKEYFACILITY TYPE:
850
ADDRESS:4167 PHELAN ROADTELEPHONE:
(760) 868-3036
CITY:PHELANSTATE: CAZIP CODE:
92371
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 20DATE:
10/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Vicki DenbleykerTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Preschool Site Supervisor Vicki DenBleyker, today for the purpose of conducting an unannounced Required 1 year Annual inspection for the Phelan Elementary State Pre-school . There were 20 children present, with 4 teachers providing care.
Hours of operation are: Monday thru Friday (between 8:15 AM – 11:15 AM and 12PM - 3PM).

During the time of the inspection, LPA observed and reviewed records to verified accuracy:
1. Sampling of children's (5) records (See LIC 857)

2. Sign In and Out sheets were inspected.

3. Emergency contact information observed

4. Parent board observed

5. Staff personnel files reviewed for educational and certification (See LIC 859 )

6. Pediatric CPR and First Aid training for one staff (09/10/2024)

7. Mandated Reporter Training

8. Emergency Fire Drills were current and up to date

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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: SJUSD-PHELAN ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 364812086
VISIT DATE: 10/07/2022
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INDOOR INSPECTION:
During today’s inspection, LPA toured the location. Observed teacher/child ratio, care and supervision. ** Fire Extinguisher up to date and operable.
Bathrooms (2) were inspected and LPAs noted all toilets (5), sinks (4) were sanitary and operational. LPAs observed soap, paper towel and toilet paper. classroom has a water fountain, cubbies with children's names identified. All flooring was found to be clean and safe
*. Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children and stored in locked cabinet. Trash cans/storage containers for solid waste were covered with tight-fitting tops that are kept on, and in good repair. *Snack/lunch menu’s, Allergy list were reviewed and posted. Food and snacks were provided by the district to children in care. Location had telephone service, heating/cooling, lighting and ventilation were evaluated. *First Aid supplies were discussed and inspected along with medication policy, including labeling, administering and appropriate storage in original container. A review of medication policy indicated prescription medications are administered with “parent's written permission”. Certified staff administers medications and documents: date, time and dosage onto a log (School Nurse). *There is Children isolation area as needed ,

OUTDOOR INSPECTION
*Outdoor area and equipment inspected for safety, wood chips material, good repair and age appropriateness, LPAs noted shade, and drinking water: No pool or bodies of water observed on the premises.

ADMINISTRATION:
Site supervisor is aware the Department has “full inspection authority” per Health and Safety Code 1596.852, 1596.853, and 1596.535. *There were no excluded individuals present;
**All staff present received fingerprint cleared and associated,
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
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: SJUSD-PHELAN ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 364812086
VISIT DATE: 10/07/2022
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LPA discussed the following:
Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility (Center or family child care home) are aware of situations that present the greatest danger to children. These situations include:
· Serious health and safety violations resulting in Type A citations;
· Non-compliance conferences; or
· Efforts by the Department to revoke a facility’s license. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Failure to meet the posting requirements shall result in an immediate civil penalty. In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.

Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov. Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe”.

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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
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: SJUSD-PHELAN ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 364812086
VISIT DATE: 10/07/2022
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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

There were no citations issued because of this inspection, Center is operating in compliance with Title 22 Regulations.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Site Supervisor Vicki Denbleyker. A copy of the Appeal Rights (LIC 9058) was given and explained. Site Supervisor signature on this form acknowledges receipt of these rights.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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