364840047-6-7-2023-12-CC-KZIS-CSKVAN-20230607161613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364840047
Report Date: 06/07/2023
Date Signed: 06/07/2023 04:16:20 PM

Document Has Been Signed on 06/07/2023 04:16 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:	CALVARY CHAPEL LAKE ARROWHEAD ROCK PRESCHOOL		FACILITY NUMBER:	364840047
ADMINISTRATOR:	ELISA ELLIS		FACILITY TYPE:	850
ADDRESS:	101 GRANDVIEW ROAD		TELEPHONE:	(909) 337-2468
CITY:	TWIN PEAKS	STATE: CA	ZIP CODE:	92391
CAPACITY:	38	CENSUS: 18	DATE:	06/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Administrator Elisa Ellis		TIME COMPLETED:	04:30 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 June 7, 2023, at 12:15 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Required one year inspection and met with Administrator Elisa Ellis. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator. 18 preschool age children and four staff members were present in the facility during this inspection. The Center is located on the grounds of Calvary Chapel Lake Arrowhead Church. The Center consists of three classrooms, four children's restrooms, and two outdoor play spaces. Administrator accompanied LPA inside and out of the facility during this inspection. The facility operates from 7:00am until 5:30pm Monday through Friday. Indoor/Children’s Area: Child care center is clean, safe, 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 inaccessible via cabinets equipped with child safety latches or in high cabinets out of the children reach. Zero poisons were stored within the preschool center. The furniture/equipment was good condition. The Center was free of flies, other insects, or rodents. All classrooms were equipped with tables and chairs to meet children’s needs. All play equipment and materials used by children are age-appropriate, children have individual cubbies labelled with their name for their clothing, personal belongings and or bedding. Trash cans for solid waste have tight fitting lids. All materials and surfaces are toxic free. No fireplaces were present in the preschool classrooms. Carbon monoxide detectors, smoke detector and fire extinguishers were located in each classroom and throughout the Center. The Center had working telephone service on the premises. There is an isolation room for children who become ill while in care located in the Administrators office. The facility maintains a comfortable temperature at all times. Electronic sign in/out sheets were available and are completed each day. Per LPAs review, the electronic sign in/out sheet reflected an accurate child count. Report continued on page two

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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: CALVARY CHAPEL LAKE ARROWHEAD ROCK PRESCHOOL	FACILITY NUMBER: 364840047
	VISIT DATE: 06/07/2023

NARRATIVE

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Smoking prohibited on the premises. Staff complete daily inspections for illness. LPA did not observe prohibited child care items at this time. Firearms/weapons are not allowed or stored on premises. There are no bodies of water on the premises. The Center does not provide meals or snacks. All meals are provided by the parents and stored in labeled lunch boxes. Children have access to water while in the classrooms via personal water bottles.

Napping
Cots used are utilized by the children during nap time. LPA observed the Center during nap time and noted that the cots were arranged so no exit is blocked.
Restrooms
There are four children's restrooms located on the grounds. Each of the three classrooms has a restroom with at least one toilet and one sink. When the children are outside they utilize the churches restroom located near the outdoor play space. Changing tables were observed in Classroom 1 (Bees) and Classroom 3 (Butterflies). At the time of this inspection all restroom areas were in safe and in sanitary operating condition. The children's restrooms deliver hot and cold water. LPA observed paper towel (touchless) and soap dispensers were available for the children. Additional restrooms available for the staff in the preschool office.

Outdoor
The Center has two outdoor play areas. One of the outdoor play areas consisted of large and small climbing equipment, monkey bars, a canoe, tricycles, balls and additional materials which met the ages of the children enrolled. The climbing equipment was placed on wood chips and was securely anchored to the ground. All equipment was free from hazards, holes, broken items. A fence surrounds each of the outdoor area. The second play area had a dramatic play kitchen space, a sand box, and additional materials which met the ages of the children enrolled. No bodies of water were observed in the license spaces of the Center. When the children are engaged in outdoor play they have access to drinking water via personal water bottles.

Report continued on page three

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CALVARY CHAPEL LAKE ARROWHEAD ROCK PRESCHOOL	FACILITY NUMBER: 364840047
	VISIT DATE: 06/07/2023

NARRATIVE

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Other: Electrical outlets are inaccessible, there are no recalled and or prohibited toys or sleep/play equipment observed on the premises.

Health Related Services

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 Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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. At the time of this inspectio zero medications were being administered.

Staff/Personnel Records
LPA reviewed five child records and five staff files during this inspection. Records were complete and contained the required documentation. A staff member was on site who had current CPR/First Aid

Facility Records

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

Posting Requirements
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393L), car seat law (PUB 269), emergency disaster plan.

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

Report continued on page four

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CALVARY CHAPEL LAKE ARROWHEAD ROCK PRESCHOOL	FACILITY NUMBER: 364840047
	VISIT DATE: 06/07/2023

NARRATIVE

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Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address: 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 center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email to insectionprocess@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.

No deficiencies were observed during this inspection.

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 Elisa Ellis.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC809 (FAS) - (06/04)

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