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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364812086
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:37:36 AM

Document Has Been Signed on 09/25/2024 11:37 AM - 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/
DIRECTOR:		BRENDA NOPWASKEYFACILITY TYPE:
850
ADDRESS:4167 PHELAN ROADTELEPHONE:
(760) 868-3036
CITY:PHELANSTATE: CAZIP CODE:
92371
CAPACITY: 48TOTAL ENROLLED CHILDREN: 16CENSUS: 14DATE:
09/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:24 AM
MET WITH:Vicki DenblkykerTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 9/25/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced Annual/Random inspection at the facility and met with The supervisor, Vicki DenBleyker. LPA explained the purpose of the visit and was granted access to the facility. Upon arrival, LPA observed 1 classroom in use, with a total of 15 children and 3 teachers present. The hours of operation are 8:15 AM – 11:15 AM Monday - Friday. No PM class at this time. Incidental Medical Services (IMS) were discussed during the visit.
Physical Plant: LPA conducted a thorough inspection of the preschool classrooms. The furniture and equipment were evaluated for age appropriateness and condition, and LPA noted that all items were in good repair, free from sharp, loose, or pointed parts. The floors in all rooms were observed to be clean and safe. LPA also confirmed the presence of carbon monoxide detectors in each classroom. The facility has a fire extinguisher (last inspected on 6/12/2024), a smoke detector, and a carbon monoxide detector. Telephone service was verified. Heating, lighting, and ventilation were adequate throughout the facility. Each child is assigned a labeled cubby for their belongings, and the activity schedule is posted in each classroom. Children are encouraged to bring their water bottles; additional water is available for refills at the school.
Napping: No nap for this program.
Health Services: LPA inspected the First Aid kit, which contained the current edition of a first aid manual, sterile dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, a thermometer, and antiseptic solution. The supervisor was provided with a list of recommended first-aid supplies. Upon arrival, children are screened for illnesses using a no-touch thermometer and an overall wellness check. A review of the medication policy showed that prescription medication is administered only with parental consent.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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: SJUSD-PHELAN ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 364812086
VISIT DATE: 09/25/2024
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The school nurse is responsible for administering medication, with all dosages, dates, and times recorded in a log. Medication is stored securely at the front school, labeled correctly, and kept in its original container unless parents request a daily return. Once the medication expires, it is sent home with the parent for disposal. Currently, there is a child in care with IMS needs. The school office includes a designated area for isolating and caring for ill children, which is equipped with a mat. An isolated toilet and sink for sick children are available in the staff restroom.
LPA also noted that all containers used for storing solid waste, including moveable bins, were equipped with tight-fitting lids and were leakproof and rodent-proof. Disinfectants, cleaning solutions, poisons, and other hazardous items were securely stored outside children’s reach. The classroom temperature was confirmed to be less than 20 degrees cooler than the outside temperature.
Bathrooms:
LPA inspected the bathroom facilities, which include three toilets and 2 sinks. All toilets and sinks were clean, functioning correctly, and age appropriate. The water temperature was safe, and soap, toilet paper, and towels were readily available.
Outdoor Area:
The outdoor play area was thoroughly inspected, and the fences were observed to be at least five feet high. The play equipment met health and safety standards regarding cushioning materials, condition, and age appropriateness. The play area has a playground cushion and concrete. The play area was inspected and found to be free of hazards and inaccessibility to bodies of water. The preschool has a separate playground yard for school-age children. There is a bike path, basketball hoop, and other age-appropriate toys. LPA observed under high climbing equipment, swings, slides, and other similar equipment have cushioned with material that absorbs falls.
A fire drill/earthquake log is posted in the office, and the center conducts disaster drills at least every six months. The fire and earthquake drills are up-to-date, and a current roster is available.
Transportation Arrangements: The school does not provide transportation.
The parent board was reviewed and found to have all required forms posted. The sign-in and sign-out sheets were also examined, confirming that the teacher-to-child ratio was maintained and staff names were recorded correctly.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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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: 09/25/2024
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Staff Records/Children's Records:
LPA reviewed both staff and children's records. It was confirmed that at least one staff member present had current CPR and First Aid training. All staff members complete Mandated Reporter training every two years and have received the required Measles, Pertussis, and Influenza vaccinations. Fingerprinting for all staff is associated with the facility.
LPA reviewed records for 5 children, all complete, and included the parent’s signature.
Food Service: All the food is from the school cafeteria. The facility provides morning snack. Allergy lists are posted in the classroom. LPA observed an appropriate amount of food and snacks, and the staff prepared lunch (with gloves). The chemicals are kept separate from the food (kitchen adjacent to the kitchen sink or locked inaccessible in classroom cabinets). LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies. Menus are posted at least one week in advance and made available for review by the parents.
The following general information was discussed during this inspection:

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.
*All Licensing reports are available for review online 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.
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
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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
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: 09/25/2024
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**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 childcare facility are aware of situations that present the greatest danger to children
**Center Director advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations as well as quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation with regard to exemptions and parents' rights was also discussed.
Criminal Record Clearance - Child Care Centers Licensee [or 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.
Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
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
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: 09/25/2024
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For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.
Incidental Medical Services (IMS) - Child Care Centers IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS: 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 PIN 22-02-CCP. 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-carecenters/. IF THERE IS NO CHILD AT THE FACILITY THAT CURRENTLY NEEDS IMS, USE AS FOLLOWS: 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/.
MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or 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.
Notice of Site Visit - Centers and Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.
No deficiencies are being cited at this time; the facility complies with Title 22
An exit interview was conducted, and the report was reviewed with the supervisor, Vicki Denblkyker.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC809 (FAS) - (06/04)
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