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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840739
Report Date: 12/21/2023
Date Signed: 12/21/2023 12:18:21 PM

Document Has Been Signed on 12/21/2023 12:18 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:PSD/NORTHGATE HEAD STAR/STATE PRESCHOOLFACILITY NUMBER:
364840739
ADMINISTRATOR:STEPHANIE RODRIGUEZFACILITY TYPE:
850
ADDRESS:17251 DANTE STREETTELEPHONE:
(760) 951-1425
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 12DATE:
12/21/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Irma G. Santos, Acting DirectorTIME COMPLETED:
12:15 PM
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On December 21, 2023, Licensing Program Analyst (LPAs) Calloway and Ali made an unannounced inspection for the purpose of conducting a Required Annual inspection. LPAs met with Acting Facility Director who granted access. LPAs toured the facility with the Director and observed 12 children in active play, 1 teacher, and two teacher’s aides. The preschool consists of 2 classrooms, one classroom is currently closed. The facility operates from 7:30 am to 4:30 PM Monday-Friday.

Physical Plant: LPAs observed clean and safe classrooms, telephone service, heating, lighting, and ventilation are adequate. There are cubbies for children's belongings (labeled) in each classroom. Furniture, equipment, toys, and materials were age appropriate. Drinking water is available inside the classrooms in the form of water dispensers and disposable cups. Sufficient napping (cots) for children (labeled). The bedding is stored separately and per Director, it is washed weekly. First Aid Kits were observed in each classroom. There is an Emergency Survival Kit Bin kept sealed in the empty classroom. Fire alarm pull, fire extinguisher, smoke detector and carbon monoxide detector (operable). One trash can in the classroom did not have a lid. LPAs recommended it be removed.

Bathrooms: LPA inspected the children's bathroom. There are 3 toilets and 3 sinks, functioning properly and age appropriate (no hazards). LPA observed soap, toilet paper, and paper towels readily available. Staff restrooms are in the hallway outside of the classroom.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739
VISIT DATE: 12/21/2023
NARRATIVE
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Kitchen: There is a clean, fully equipped kitchen with refrigerator, freezer, convection oven, microwave, and sink. The facility provides breakfast, lunch, and afternoon snacks. Menus are posted. LPA observed allergy list posted. There are also allergy lists in each classroom. LPA observed an appropriate amount of food and snacks. Knives were in the cabinet (up high). The chemicals are kept separate from the food. Cleaning supplies are kept underneath the sink (not locked). Per Director, the kitchen door remains locked during day care hours. Fire extinguisher next to exit door (full/green).

Outside: Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriate. LPA observed a small play structure with shade provided and a cushioned surface. There is also a large play structure with wood chips underneath. Both structures are securely anchored. There is artificial grass area for active play. The playground was observed to be free of debris. Drinking water is available in the form of a water cooler and disposable cups. There are no bodies of water on the premises. There are 2 storage sheds (locks observed).

Other: Children and staff files were reviewed. Current Pediatric CPR and First Aid (expires 8/19/2025). Transportation is provided via First Student Bus Co. and medical policy reviewed. Disaster Drills: Fire/Earthquake (current 12/2023) and Roster (current). Children are inspected for illnesses as they arrive. There is a separate room labeled isolation room for isolation and care of ill children in a room adjacent to the office. There is a separate cot with fresh linens available for each ill child. Teacher/child ratios were observed as well as sign in/out sheets (digital tablet).

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739
VISIT DATE: 12/21/2023
NARRATIVE
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Center Director was reminded to access the Licensing website at www. ccld.ca.gov. to obtain information about the most recent regulatory changes and the Quarterly Updates. Medications are stored in a backpack (locked and stored at door of each classroom and small refrigerator in the kitchen if needed). A review of medication policy indicated that prescription medication is administered only with parent's written permission. The management staff administers medication and documents the dosage, date and time onto a log. Medication is brought and taken home by the parent daily or stored in the backpack. Medication is properly labeled and stored in its original container.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies. 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.

The On Duty Worker is available Monday through Friday at (661) 202-3318 from 8:00 AM - 5:00 PM for questions, information, and Unusual Incident Reporting.

Lead Poisoning: For more information, go to the California Childhood Lead Poisoning Prevention Branch’s website at www.cdph.ca.gov/programs/clppb,or call them at (510) 620-5600.

Additional forms and a copy of Title 22 Regulations may be obtained at the department's website: www.ccld.ca.gov. Center informed to review updates/regulations on the department website.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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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: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739
VISIT DATE: 12/21/2023
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Per Title 22 Regulations, there are deficiencies cited during this inspection. See 809D pages.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Irma G. Santos, Acting Director at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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Document Has Been Signed on 12/21/2023 12:18 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 12/21/2023 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review the licensee did not comply with the section cited above in the facility did not have a current lead/water test for review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/04/2024
Plan of Correction
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Per Director prooof of water test will be submitted by POC date of 1/4/24.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in S1 did not have mandated reporter in their staff file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Per Director the mandated reporter training will be submitted to Licensing by POC date above.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/21/2023 12:18 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 12/21/2023 at 12:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above in there was not a Director's packet received in the Licensing office within 10 days of the Director changing which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Director will submit the packet for qualifications to Licensing by POC date above 12/28/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


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