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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147750002
Report Date: 05/21/2024
Date Signed: 05/21/2024 05:11:08 PM

Document Has Been Signed on 05/21/2024 05:11 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ICOE- ELM ST STATE PRESCHOOLFACILITY NUMBER:
147750002
ADMINISTRATOR/
DIRECTOR:		KATHLEEN DUNCANFACILITY TYPE:
850
ADDRESS:800 W ELM ST BLDG ATELEPHONE:
(760) 873-5123
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 12DATE:
05/21/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:21 PM
MET WITH:Marie Morris, SIte SupervisorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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On 5/21/2024, Licensing Program Analysts (LPAs) Crystal Ali and Kris Diaz arrived at the facility to conduct an Annual Random Inspection. LPAs was met by Marie Morris, Site Supervisor and permitted to enter the facility. LPAs toured the facility in accordance with the facility sketch with Marie. During the inspection, LPAs observed 15 children and 2 staff providing care and supervision. Facility operates Monday through Friday from 7:45am to 5:15pm.
Staffing Ration and Capacity: Facility consists of one classroom, one staff bathroom, one children’s bathroom, kitchenette area, and one outdoor play area. Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met.
Physical Plant: Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPAs observed sign-in sheets completed by each parent/guardian per requirements. LPAs observed individual storage for children's belongings. The children have access to water via individual water bottles and the water fountain on the playground. Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition. Smoke and carbon monoxide detectors are operating according to Fire Marshall standards. First Aid Kit with all components. Trash cans with tight-fitted lids were observed.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICOE- ELM ST STATE PRESCHOOL
FACILITY NUMBER: 147750002
VISIT DATE: 05/21/2024
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Napping: Children are provided napping daily from 12pm-2pm. Children are provided cots to sleep on during nap time. Napping materials are cleaned on Mondays.
Kitchen: There is a clean, fully equipped kitchen with a refrigerator, freezer, and microwave oven. The school cafeteria provides food for those students that qualify for the food program. The facility provides morning snack, lunch, afternoon snack. Allergy lists are posted in the kitchen (on refrigerator) and in their record file. LPAs observed an appropriate amount of food and staff preparing snacks (with gloves). Chemicals, soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies and located in the staff bathroom with safety gate. There are no knives in the kitchen. Facility uses plastic knives to cut fruit for the children. LPAs observed that food preparation and storage areas are kept clean and free of litter and rubbish. Menus are posted at least one week in advance and made available for review by the parents. The facility does participate in the food program. Daily activity schedules are posted showing meal/snack times, and specific activities. Food allergies are noted and are posted in the kitchen on the refrigerator. There is outside food allowed via children bringing their own lunches. The cabinet under the sink needs a safety latch. The old safety latch is worn out. Fire Extinguisher: Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 4/19/24 at 9:30am. The fire extinguishers (3A40BC) are reading in green and meets the Fire Marshall Codes and Standards (last serviced 11/21/2023). Two fire extinguishers is at the front and back door of classroom.
Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Girls bathroom has 1 toilet flushed properly and 1 sink. Boys bathroom has 1 toilet flushed properly and one sink are reachable by the children. Each restroom has adequate toilet paper, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICOE- ELM ST STATE PRESCHOOL
FACILITY NUMBER: 147750002
VISIT DATE: 05/21/2024
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Medication: A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The facility teachers pass out medication. Medication is labeled correctly and stored in its original container. Currently no children are on medication. Medication is to be kept in the staff office locked inaccessible to children. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. Isolation area is at the back of the classroom away from rest of the children where a teacher will remain with the child until the parent comes. There are currently no children in care with IMS needs.
Transportation: The facility does not provide transportation for the children.
Lead Testing/Drinking Water: The facility has had lead testing completed 4/5/23. Copy of report was provided to LPA Ali. Facility passed the lead test.
Outdoor Activity Space: The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. There is an approved wavier for the playgrounds. There are four playground areas that are shared on rotation with the other facilities on campus. Playyard#1 has large, anchored play equipment with slide, play yard #2 has tricycle track, play yard #3 has small play equipment that is anchored in sand, play yard #4 is not accessible. There are two areas in the playground that have a drainage cover for when it rains due to the dip in the ground to reduce flooding. The facility will continue to provide 100% supervision when outside in the playground. Children are provided tap water via individual drinking bottles. There is adequate shaded area for rest. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICOE- ELM ST STATE PRESCHOOL
FACILITY NUMBER: 147750002
VISIT DATE: 05/21/2024
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Records/Documentation: LPAs reviewed with facility representative the LIC 311A, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. All other records are in compliance.

No deficiencies cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

A notice of site visit was given and must remain posted for 30 days. A copy of this report and copy of appeal rights were provided to facility representative.



Exit interview conducted and report was reviewed with the Site Supervisor, Maria Morris.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICOE- ELM ST STATE PRESCHOOL
FACILITY NUMBER: 147750002
VISIT DATE: 05/21/2024
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Criminal Record Clearance - Child Care Centers
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.
Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. .
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ICOE- ELM ST STATE PRESCHOOL
FACILITY NUMBER: 147750002
VISIT DATE: 05/21/2024
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LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
Incidental Medical Services (IMS) - Child Care Centers
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/.
PIN 22-05-CCP
MyChildCarePlan.org – Child Care Centers
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.
Subscribe to CCLD important information - Child Care Centers
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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