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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402211
Report Date: 10/26/2021
Date Signed: 04/06/2023 02:51:41 PM

Document Has Been Signed on 04/06/2023 02:51 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FIRST UNITED METHODIST PRESCHOOLFACILITY NUMBER:
197402211
ADMINISTRATOR:SANDRA CLEMONSFACILITY TYPE:
850
ADDRESS:39055 10TH STREET WESTTELEPHONE:
(661) 272-1334
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 16DATE:
10/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Megan FletcherTIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Carol Heath met with the Assistant Director Megan Fletcher, for the purpose of conducting Annual random inspection of the preschool school. During this inspection, LPA toured center indoors and outdoors according to the facility sketch. This facility is a combination center with a school age component. The facility consists of a total of 6 preschool classrooms and 3 school age classrooms. LPA observed 17 children upon arrival. During the inspection 3 teachers observed to be monitoring children as they napped. Facility operates from 6:30 am to 6:30 pm (Monday - Friday). Incidental Medical Services (IMS) were discussed.

Classrooms: In each classroom LPA observed age appropriate furniture, equipment, toys and materials. The classroom was observed to be clean, safe and free of any health or safety hazards. Telephone service was verified as well as adequate heating, lighting, and ventilation. There are cubbies in which children can store their belongings. LPA observed water dispensers (jugs) and disposable cups for drinking water in each classroom.

Medications: Medications are stored in a locked storage cabinet in the director's office.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 10/26/2021
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Fire Extinguisher and Smoke Detector/carbon Monoxide: Facility has an intercom system and surveillance video on the premises, which covers each classroom and outside play area. Fire extinguisher and Smoke detector/carbon monoxide detector were observed and tested in each classroom by LPA

Bathrooms: LPAs inspected and observed the children's bathrooms, which are designated by boys and girls. The boys bathroom consisted of (1 toilets, 2 sinks, 1 urinal) the girl's bathroom consist of (2 toilets, & 2 sinks) Toilets and sinks are functioning properly and are age appropriate. LPAs observed soap, toilet paper and paper towels readily available.



Outdoor: Outdoor play equipment was inspected for health, safety, the playground consists of sand material that will provide cushioning in the event a child falls. The sand is (raked daily) and was observed to be clear and free of debris. LPA observed large and small play structures are securely anchored to the ground. There is a shaded canopy over the play structures and adequate shade. Drinking water is available. Play area was inspected for hazards and inaccessibility to bodies of water.

Children are inspected for illnesses as they arrive. A review of medication policy indicated that prescription medication is administered and only with parent's written permission. The Director or the Administrator Coordinator administers the medication and documents the dosage, date and time onto a log. Medication is brought and taken home by the parent daily or retained in a lock cabinet (director office) or a refrigerator (director office) properly labelled. Medication is properly labeled and stored in its original container.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/06/2023 02:51 PM - It Cannot Be Edited


Created By: Carol Heath On 10/26/2021 at 04:55 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: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 Mandated Reporter Training. LPA Heath observed 5 teachers without training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/01/2021
Plan of Correction
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The director will email LPA the Mandated Reporter Training certification.
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview and record review, the licensee did not comply with Tuberculosis Test. LPA Heath observed 5 teachers and 3 of teachers' TB were expired, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/15/2021
Plan of Correction
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The Director will email the LPA all the doctor appointment date.
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:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2021


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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 10/26/2021
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Menus are posted in the office. Allergy lists are posted in each classroom and main office. LPA observed appropriate amount of food and snacks. The chemicals are kept separate from the food. The facility has ensured and establish measures to keep the facility free of flies and other insects or rodents.

There is an operating telephone in the Child Care Center. LPAs observed fully charged and operational 2:10ABC fire extinguisher located in each classroom. This facility has one or more functioning carbon monoxide detectors that meets statutory requirements. All storage containers for solid waste, including moveable bins, have tight fitted covers that are kept on, and are in good repair.

Teacher child ratios were observed and care and supervision was evaluated to determine if the basic needs of children is appropriately met.

Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Fire/earthquake drills current. Children's records and staff records were reviewed.

CPR/First Aide: The center has 5 staff are currently certified in pediatric CPR and first aid which expires on 2022.

Children files and Staff files were complete with all required licensing forms. The facility roster was up to date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 10/26/2021
NARRATIVE
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Fingerprint clearances: All staff have been fingerprinted and associated to the designated license number.

Licensing Forms: The facility had all the required licensing forms posted. The parent board was reviewed and has all of the required forms posted.

Fire/Earthquake Drills: LPA observed the Fire/earthquake drills current (Date: 10/14/2021).

The following general information was discussed during this inspection:

Incidental Medical Services (IMS) policy was discussed. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Mandated Reporter Training Requirements: §1596.8662 - As of January 1, 2018, child care providers, administrators, or employees who work in a licensed 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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 10/26/2021
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Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
*All Licensing reports are available for review on-line and are considered public information. Summary: Assembly Bill 2621 added Section 1596.819 to the Health and Safety Code, to require the Department to post certain licensing information for CCCs and FCCHs on its public internet website.
Safe Sleep

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [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.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: FIRST UNITED METHODIST PRESCHOOL
FACILITY NUMBER: 197402211
VISIT DATE: 10/26/2021
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Fingerprint clearances and transfers: Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. If a fingerprint clearance has been obtained through the Department, Licensee may request a transfer of a criminal record clearance from one state licensed facility to another using form LIC 9184. Child Care Centers: Licensee [or 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.

Notice of Site Visit

A notice of site visit was given and must remain posted for 30 days.

There are Type B citations issued during today's inspection.

Exit Interview

Exit interview conducted and report was reviewed with Megan Fletcher (Assistant Director).

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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