197418481-9-1-2023-12-CC-IORA-CV9VGC-20230901162518

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418481
Report Date: 09/01/2023
Date Signed: 09/01/2023 04:25:26 PM

Document Has Been Signed on 09/01/2023 04:25 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:	PACOIMA CHARTER SCHOOL		FACILITY NUMBER:	197418481
ADMINISTRATOR:	FAJARDO, SYLVIA		FACILITY TYPE:	850
ADDRESS:	11016 NORRIS AVE		TELEPHONE:	(818) 899-0201
CITY:	PACOIMA	STATE: CA	ZIP CODE:	91331
CAPACITY: 92	TOTAL ENROLLED CHILDREN: 92	CENSUS: 43	DATE:	09/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Angela Tilghman-Paczesmy, Preschool Supervisor		TIME COMPLETED:	04:30 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 9/01/2023 Licensing Program Analyst (LPA) Isabel Ortega met with Preschool Supervisor, Angela Tilghman-Paczesmy and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. During inspection LPA observed 43 children and 10 staff providing care and supervision. Facility operates in four classrooms referred to as classroom #1, #2, #3 and #4 (Teacher’s name utilized to identify the classroom). There are a total of four classrooms, playground and one shed on the playground utilized only for equipment. There is other three sheds utilized for staff and there is an emergency food supply in the kitchen. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, AC, lighting, and ventilation were evaluated. LPA observed individual storage for children's belongings. An isolation area was inspected, which takes place in the nurse health office. Children have the option for rest time and quiet time if needed.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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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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: PACOIMA CHARTER SCHOOL	FACILITY NUMBER: 197418481
	VISIT DATE: 09/01/2023

NARRATIVE

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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 staff daily and as needed. Staff custodian restocked of toiletries, disinfects and sanitizes the restroom. Children are provided with cots for nap time and parents bring blankets for children and are taken home every Friday for wash.

Facility’s hours of operation for classrooms #1, #2, and #3 are Monday through Friday from 8:00 a.m. to 4:00 p.m. Room #4 operates Monday through Friday from 8:00 a.m. to 11:00 a.m. Facility provides breakfast, lunch and afternoon snack for children enrolled. Food allergies are noted in the kitchen area and classroom. The menu is posted in each classroom visible to parents.

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 on 08/09/2022) and meets the Fire Marshal codes and standards all were observed and in operable condition.

Emergency Drills are conducted every sixth month last drill was conducted and documented on 08/31/2023 at 10:00 a.m.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

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: PACOIMA CHARTER SCHOOL	FACILITY NUMBER: 197418481
	VISIT DATE: 09/01/2023

NARRATIVE

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Trash cans with tight lids were observed. 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, has hot running water and free from hazards. Cleaning supplies are out of reach of children.

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. Climbing structures 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.

Children bring their own water bottles from home and water bottles are available throughout the day during indoor and outdoor play (LPA observed extra cases of individual water bottles). Facility provided sample of analysis sample water collected on 12/27/2022 and results for lead were provided on 12/30/2022 with less than 1 ppb which is less than the 5.5 ppb allowed.

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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: PACOIMA CHARTER SCHOOL	FACILITY NUMBER: 197418481
	VISIT DATE: 09/01/2023

NARRATIVE

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Facility maintains adequate teacher child ratio. Care and supervision were evaluated and determine to meet the basic needs of children. 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.
Directors and teachers are currently certified in Pediatric CPR/First Aid. Child Care Provider Mandated Reporter (AB1207) training for staff and Supervisor is current.

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 the Child Care Provider Mandated Reporter training every 2 years. www.mandatedreporterca.com.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: PACOIMA CHARTER SCHOOL	FACILITY NUMBER: 197418481
	VISIT DATE: 09/01/2023

NARRATIVE

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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.

All staff 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/

Per Title 22 Regulations facility is in compliance, no deficiency will be issued today. An exit Interview was conducted with facility Center Preschool Supervisor Angela Tilghman-Paczesmy. A copy of this Report, a Notice of Site Visit and appeal rights were provided on this day.

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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023

LIC809 (FAS) - (06/04)

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