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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801387
Report Date: 08/22/2023
Date Signed: 08/22/2023 04:38:08 PM

Document Has Been Signed on 08/22/2023 04:38 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:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801387
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
830
ADDRESS:329 SOUTH MILL STREETTELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
08/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Parks, MadisannTIME COMPLETED:
01:16 PM
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On 08/22/23 Licensing Program Analyst (LPA) Beneroso met with the Director, Madisann Parks and conducted an Annual Random inspection. LPA toured and inspected the Infant program in accordance with the facility sketch. LPA observed 8 infants with 3 Teachers providing care and supervision. The facility consists of 1 Infant classroom. The center also operates a Pre-School Program with a Toddler Component (#153801077). The hours of operation are 6:00 am - 6:00 PM Monday -Friday.

Indoor/Children's Area: Indoor activity space for is divided into play time/ feeding area and nap time area. Infant center is equipped with age-appropriate furniture and equipment including cribs, mats, changing table and feeding chairs. Per Director equipment, toys and furnishings are sanitized daily.

Furniture and equipment were inspected for age appropriateness and good repair, low chairs and tables, changing table padding thickness is within regulatory requirements and located within arm's reach of a sink. Drinking water is available inside the classroom, center uses drinking fountains. Bedding is changed daily for the younger infants. Teacher child ratios were observed, and staff names recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

Per LPA's observations, there are no bodies of water in the facility

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387
VISIT DATE: 08/22/2023
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The center’s Infant Room (indoor) was observed to be clean, safe, sanitary and in good repair, there are no potentially hazardous areas observed. Floors are clean and safe, cleaning compounds are inaccessible (kept in a storage room that is kept locked), furniture and equipment in good condition. Each infant has own cubby for their belongings and diapers.
LPA observed the carbon monoxide, Fire Extinguisher and smoke detector in working condition. There is a working telephone on the premises, isolation area for ill children is in the director’s office. Room temperature is comfortable, a fully stocked First Aid Kit was observed, sign in/out sheets were reviewed and contain legal signatures, no baby walkers or other prohibited play equipment was observed on the premises.

Outdoor: Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. The outdoor play area was observed to be free of debris. There is a storage shed that remains locked. LPA observed a jungle gym having lose screws. A type B Violation has been cited for this Deficiency. Staff inspect outside play area prior to children exiting to the play area.

Outside area is completely fenced in with chain link fence. Activity space is physically separate from the space used by children in the preschool component. The outdoor space isfree of hazards, cushion material to absorb fall. LPA observed adequate outside shade, play ground free from debris.



Children/Infant Records: Infants' files have Needs and Services Plan/Individual Sleep Plan in their files were observed in their files. Immunization records for one of the infants was missing from file. A Type B Citation was issued for this Deficiency. Staff conduct 15 minute checks on Infants as they sleep (log observed).

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387
VISIT DATE: 08/22/2023
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Infant Food Service: Low chairs and seating equipment in good repair. Food bought from home is labeled with infant name and date (currently no outside food brought inside the center, beside breast milk).

Posting Requirements: LPA observed Licensing and Parent boards to be incompliance including the required posting (menu, daily schedule, community activities, licensing required documents). Fire/earthquake drills current, last fire drill was conducted 07/05/2023. Roster current and maintained. Staff present have current CPR/First Aid expire 03/11/2025. Mandated Reporter is maintained current, it expires 03/13/2024.
Staff Records: LPA reviewed files for Director Qualifications, immunization, licensing forms. Staff Records were reviewed and found to be complete.


Napping: There are mats and cribs available for nap time. Each crib is used for one infant at a time, bedding changed daily or as needed, cribs and mats are arranged to allow staff to reach an infant without having to step over an infant. Bedding is stored as to not come in contact with other bedding.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The Licensee will not be providing IMS to the children at this time.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387
VISIT DATE: 08/22/2023
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Director advised of the requirement to report Unusual Incidents. Licensee informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: 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 the day care center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.



Child Care Advocates: You can now sign up for Quarterly Updates and PINs for one or more programs through our DSS website at www.ccld.ca.gov Click on “Receive Important Updates” located in the right middle part of the page, immediately above the Quick links. Put your email address and choose which program(s) you would like to subscribe to and click “subscribe. Applicant was advised that all LIC forms can be found at: https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387
VISIT DATE: 08/22/2023
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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 licensed 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.

Two Type B Violation was cited during inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director, Madisann Parks
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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Document Has Been Signed on 08/22/2023 04:38 PM - It Cannot Be Edited


Created By: Barbara Beneroso On 08/22/2023 at 12:57 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: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(o)
Fixtures, Furniture, Equipment and Supplies
(o) Playground equipment shall be securely anchored to the ground unless it is portable by design.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above. LPA observed jungle gym not properly anchored and with lose screws and pieces which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2023
Plan of Correction
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Director will remove jungle gym on 08/22/2023 and submit proof to LPA Beneroso.
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above. LPA did not observe the vaccination records for one of the intants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/25/2023
Plan of Correction
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Director will submit proof of vaccination record to LPA Beneroso by 08/25/2023.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2023


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