197409136-2-26-2025-12-CC-MRIA-DEA28U-20250226161054

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409136
Report Date: 02/26/2025
Date Signed: 02/26/2025 04:11:06 PM

Document Has Been Signed on 02/26/2025 04:11 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:	NOTRE DAME PRESCHOOL		FACILITY NUMBER:	197409136
ADMINISTRATOR/ DIRECTOR:	ANGELICA M RODRIGUEZ		FACILITY TYPE:	850
ADDRESS:	21704 GOLDEN TRIANGLE RD.#120		TELEPHONE:	(661) 255-0053
CITY:	SAUGUS	STATE: CA	ZIP CODE:	91350
CAPACITY: 44	TOTAL ENROLLED CHILDREN: 44	CENSUS: 34	DATE:	02/26/2025
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:45 PM
MET WITH:	Angelica Rodriguez, Director		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Wednesday, February 26, 2025, Licensing Program Analysts (LPAs) Mayra Rivera and Giovanni Cristales conducted an unannounced annual inspection and met with director Angelica Rodriguez who guided LPAs Rivera and Cristales on a tour of the facility. This is a preschool program that serves children ages 2 to 5 years. This program operates Monday to Friday 7:00 a.m – 6:00 p.m. Parent sign in and sign takes place at the front entrance. Teacher and child ratio were observed, and present staff are fingerprinted cleared and a least one person present who is trained in pediatric first aid/CPR is present. Annual fees are paid. LPAs Rivera and Cristales entered classroom 3 and observed 12 preschool children with staff #1 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored inside a blue top cabinet located in the bathroom. LPAs observed two trash bins with a lid. LPA’s observed children personal belongings to be stored in their individual cubbies. LPAs Rivera and Cristales entered classroom 5 and observed 12 preschool children with staff #2 and staff #3 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cleaning solutions stored inside a blue top cabinet located in the bathroom. LPAs observed two trash bins with a lid. LPA’s observed children personal belongings to be stored in their individual cubbies. LPAs Rivera and Cristales entered classroom 6 and observed 10 preschool children with staff #4 present providing care and supervision. LPA observed age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 197409136
	VISIT DATE: 02/26/2025

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observed cleaning solutions stored inside a blue top cabinet located in the classroom. LPAs observed two trash bins with a lid. LPA’s observed children personal belongings to be stored in their individual cubbies.

LPAs Rivera and Cristales observed 1 toilet and 1 handwashing sink in classroom 3 and classroom 5. Classroom 6 restroom is located in the hallway. LPAs observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPAs observed a total of 4 toilets and 4 hand washing sinks.

Heating, lighting, and ventilation were evaluated by LPA Rivera. LPA observed central AC /heater and vents located on the ceiling. LPA observed the thermostat located in the hallway and the temperature to be at 72 degrees. LPAs observed the required 2A10BC fire extinguisher located in the hallways with the valve on the green area indicating fully charged and serviced on 9/20/2024. Smoke detectors. we’re not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. The carbon monoxide detector in classroom 3 was tested and LPAs heard the sound, and it is operable. The last emergency drill was conducted on 9/16/24.

First aid kits supplies are kept inside the classrooms and LPA Rivera observed the kits to be fully equipped with band aids, gauzes, adhesive bandages, and antiseptic wipes. During this visit, director Angelica stated currently has no children with medication or severe food allergies. LPA Rivera asked if there were any poisons, firearms, weapons, or bodies of water. The director stated no firearms, weapons, no poisons nor bodies of water. LPAs did not observe firearms or weapons, poisons, nor bodies of water. Director stated the ill isolation area takes place in the director’s office and children utilize the staff restroom. Lead testing was conducted on 2/17/2023 and no lead exceedance.

LPA’s Rivera and Cristales entered the outdoor play area. LPA Rivera observed the playground to be fenced all around and the wooden gate closed and locked with a self-latch. LPA Rivera observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Rivera observed play structure equipment to be age appropriate and areas around or under climbing equipment, are cushioned with artificial turf that may absorb a fall. For adequate shade, LPA Rivera observed 2 sail triangles and 1 triangular hip roof shade structure. LPA observed a trash bin with a lid. For outdoor water drinking, children bring out water their

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 197409136
	VISIT DATE: 02/26/2025

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water hydro flask and staff water pitcher. LPA observed two water heaters located outside. One water heater temperature is at 120 and the other one reads hot.

This program provides snacks and lunch. Meals and snacks are prepared onsite. LPA Rivera informed director Angelica that any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Rivera observed water pitchers, bottles, and sippy cups in the classrooms and water filtered dispenser in the hallway. LPA observed the food preparation area to be clean and free of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including movable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects, and rodents.

The following documents were posted in a prominent, publicly area front lobby: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and PUB 269 Child Passenger System Poster, and Daily Schedule.

LPA Cristales reviewed children’s files, and staff files. LPA Rivera reviewed roster and sign in/out sheets and observed 34 signed in signatures.

LPAs Rivera and Cristales observed director Angelica Rodriguez American Red Cross Pediatric First Aid/CPR certification dated 1.20.2025, Preventative Health and Safety with nutrition and lead component dated 7.15.2023-7.16.2023 and has proof of immunization against Pertussis, MMR, and Influenza declination. Director has completed the child abuse mandated reporter training dated 2.18.2025. Director was informed that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com

The following was also discussed with director:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 197409136
	VISIT DATE: 02/26/2025

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3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

4.LIC 125 Entrance Checklist provided, and LPA informed that forms, regulations, and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.

5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present at all times.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review.

8. Immunization Requirements: 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 or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address, and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10. Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, Mandated Child Abuse Certification, MMR, TDAP, TB, influenza, or influenza declination.

11. 9. Any unusual incidents or injuries must be reported to the Department within 24 hours via telephone and within seven (7) days in writing (refer to LIC 624).

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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: NOTRE DAME PRESCHOOL	FACILITY NUMBER: 197409136
	VISIT DATE: 02/26/2025

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Director Angelica Rodriguez 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.

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. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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/.

Director Angelica Rodriguez 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.

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.

One Technical Assistance given. Please see attached LIC 9102TA. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty. Exit interview conducted and report was reviewed with administrator Tracy Hernandez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC809 (FAS) - (06/04)

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