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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407119
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:27:40 PM


Document Has Been Signed on 06/14/2023 02:27 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:POVERELLO OF ASSISI PRESCHOOLFACILITY NUMBER:
197407119
ADMINISTRATOR:SISTER VERONICA SANCHEZFACILITY TYPE:
850
ADDRESS:13367 BORDEN AVENUETELEPHONE:
(818) 364-7446
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:120CENSUS: 60DATE:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Sister Dolores VelazquezTIME COMPLETED:
02:27 PM
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On 6/14/2023 Licensing Program Analyst (LPA) Isabel Ortega met with Facility Assistant Preschool Director Sister Dolores Velazquez and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed a total of 60 children and seven staff providing care and supervision. Facility Operates in nine classrooms referred to as Nursery 1 room, Nursery 2 room, Pre-Kinder room (4-year-old), Pre-K-1 room, Pre-K-2 room, Pre K-3 room, Pre-K-4 Room, Kinder 1 room and Kinder 2 room.

There are a total of eight classrooms, a library, a clinic room, Computer lab, day care room, two large playgrounds and two shed on the playground (maintained locked) utilized for toys, equipment storage and emergency supplies.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed individual storage with children’s name labeled for children's belongings.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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Document Has Been Signed on 06/14/2023 02:27 PM - It Cannot Be Edited

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: POVERELLO OF ASSISI PRESCHOOL
FACILITY NUMBER: 197407119

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview the facility did not comply with the section cited above, no carbon monoxide detector at the facility which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/23/2023
Plan of Correction
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Facility will install at least one carbon monoxide detector in the facility by due date indicated and provide a picture of installed detector to the Palmdale Regional office by text or email.
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 and record review the facility did not comply with the section cited above according to staff facility has not had drinking water tested for lead contamination levels which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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Facility will arrange a water lead testing and submit documentation to the Palmdale Regional Office by due date and submit results to the Palmdale regional Office no later than 10 days when results are provided by email or via mail.
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: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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: POVERELLO OF ASSISI PRESCHOOL
FACILITY NUMBER: 197407119
VISIT DATE: 06/14/2023
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An isolation area was inspected, which takes place in the clinic room and a staff nurse is available. Children have the option for rest time and quiet time if needed. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper, hand soap and paper towels available. Restrooms are cleaned, restocked of toiletries, and sanitized by on the site custodian daily and as needed. The facility custodian also cleans and disinfects classrooms and the snack areas.

Facility operates Monday through Friday: two sessions are available; 8:00 a.m. to 11:10 a.m. and second session from 12:00 p.m. to 3:10 p.m. Parents provide snack for children and facility provides daily snacks for children when needed. Currently, no children have any food allergies reported but if any a designated area is noted in each classroom and snack area.

Facility had all the required posted documents: Facility License, Notice of Parent's Rights Poster, Emergency Disaster Plan, and Earthquake Preparedness Checklist.

First Aid supplies, smoke detectors, and the fire Extinguisher(2A10BC) is reading in green (serviced 1/17/2023) meet the Fire Marshal codes and standards. Facility does not have a carbon monoxide detector on the premises, a type B citation will be issued today.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: POVERELLO OF ASSISI PRESCHOOL
FACILITY NUMBER: 197407119
VISIT DATE: 06/14/2023
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Emergency Drills are conducted every sixth month last drill was conducted and documented on 05/16/2023 at 8:30 a.m. and at 12:30 p.m.

Trash cans with tight lids were observed in the classroom. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. The kitchen area is adequately equipped, clean, and free from hazards. Cleaning supplies are out of reach of children.

The outdoor play areas were inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Climbing structures and other play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. The playground is well fenced all around, and no bodies of water observed in the outdoor play area. There is adequate shade area for rest. According to facility a Lead testing sample has not been conducted, a Type B citation shall be issued.



Facility maintains adequate teacher child ratio. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. The parent board was reviewed and has all the required forms posted accessible to parents.
Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file. The facility roster was up to date and all staff have been fingerprinted and association to the designated license number.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: POVERELLO OF ASSISI PRESCHOOL
FACILITY NUMBER: 197407119
VISIT DATE: 06/14/2023
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Directors and teachers are currently certified in Pediatric CPR/First Aid which expires until 3/24/2025. Child Care Provider Mandated Reporter (AB1207) training is dated 09/10/2022.
The following Incidental Medical Services (IMS) were discussed.
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

All staff are required to take 3-hour Child Care Provider Mandated Reporter training every 2 years. www.mandatedreporterca.com.

Upon hired date all staff are required to be immunized and show proof of immunization records according to Title 22 regulations.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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: POVERELLO OF ASSISI PRESCHOOL
FACILITY NUMBER: 197407119
VISIT DATE: 06/14/2023
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Director is aware all staff are mandated child abuse reporters and are required to any suspected child abuse to the Child Abuse Hotline at (800) 540-4000.

For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

A copy of this report must be made available to the public for 3 years.

Per Title 22 Regulations facility is not in compliance, two Type B deficiencies will be issued today. An exit Interview was conducted with facility Preschool Assistant Director Sister Dolores Velazquez. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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