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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750068
Report Date: 09/03/2024
Date Signed: 09/03/2024 11:11:23 AM

Document Has Been Signed on 09/03/2024 11:11 AM - 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:PEARBLOSSOM ELEMENTARY SCHOOLFACILITY NUMBER:
197750068
ADMINISTRATOR/
DIRECTOR:		LUNA, JESUSFACILITY TYPE:
850
ADDRESS:12828 EAST AVENUE WTELEPHONE:
(661) 944-6019
CITY:PEARBLOSSOMSTATE: CAZIP CODE:
93553
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 11DATE:
09/03/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:57 AM
MET WITH:Christina KnottTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
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On 09/3/24, Licensing Program Analyst (LPA) Carol Heath met with the facility instructor, Christina Knott for the Annual/Random inspection for the preschool license by the facility sketch. They conducted a tour of the facility. Upon arrival, LPA observed 11 preschool children and 1 teacher and 2 assistants on the premises. The hours of operation are 8:25 AM—11:30 AM morning session and 12;25 PM—3:30 PM afternoon session, Monday - Friday. Incidental Medical Services (IMS) were discussed.
According to the Facility Profile LIS055 M, the facility annual fees are not current.

Indoor/Children’s Area:
LPA toured and inspected the preschool classrooms. Furniture and equipment were checked for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. There are cubbies for children's belongings labeled with their names. LPA observed age-appropriate toys and materials.
Trash cans for solid waste have tight-fitting lids, and drinking water is readily available indoors and outdoors (filtered water is available inside the center to fill each child's water bottle). All materials and surfaces are toxic-free and inaccessible; there is no fireplace. There is a working Carbon monoxide detector, smoke detector, and Fire Extinguisher 7/10/2024 (3A40BC).
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 09/03/2024
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Director Record: LPA is still waiting director, Susan Gaines’s paperwork to verify her qualification.
Advisory/Other: The First Aid kit was observed with readily available supplies (a thermometer). Electrical outlets are inaccessible and recalled and/or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children. Sign-in and sign-out sheets were reviewed. The parent board was reviewed and has posted all of the required forms. LPA provided the Fire/earthquake drills log and facility roster to the teacher.
Restrooms: LPA inspected and observed Boys’ and Girls bathrooms have 4 toilets, 3 urinals, and 4 sinks, all in working order. LPA observed that soap, toilet paper, and paper towels were readily available. Water temperature is appropriate. There is an isolation area for children who become ill while in care located near the front office; the facility maintains a comfortable temperature at all times, and first aid supplies (thermometer, bandages, scissors), sign-in and out available and completed daily. No smoking is prohibited on the premises, daily inspection is required for illness, and no prohibited childcare items are observed. Firearms/weapons are not allowed on the premises. Napping: The program is 3 1/2 hours long, and according to the director, the children do not nap.

Outdoor: The facility has one playground area for the preschool children. A wall completely fences the outside play area. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There is rubber matting and concrete areas for active play. The area was observed to be free of debris from hazards, holes, broken items, debris, and cushioning material underneath. No bodies of water were observed. There are areas for shade and rest. Preschool children have their own personal water bottles as well as disposable cups. LPA observed a storage shed for outdoor play that is off-limits to daycare children. Per teacher statements, the elementary school children utilize the storage shed toys. Daycare children have their own separate toys.

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

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 09/03/2024
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Teacher-child ratios were observed, and staff names were recorded. Care and supervision were evaluated to determine whether the basic needs of children were met and appropriate.
Health Related Services: Medications inaccessible to children; all prescription and non-prescription medications have the child’s name and are dated; written consent and instruction from the child’s representative, a plan to document and report to the child’s representative when medication is administered to a child; IMS plan on file (if applicable).
Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered only with the parent's written permission (licensing medication form—LIC9221—also used). LPA advised the Director to administer medication and document the dosage, date, and time on a log. The parent can bring and take medication home daily. Medication will be properly labeled and stored in its original container.
The parent board was reviewed and has posted all the required forms. Fire/earthquake drills are current. Sign-in and out sheets were reviewed.
Staff Records/ Children Records: Staff and Children's records were reviewed. LPA verified that at least one staff member with current CPR and First Aid Training is present. All staff complete the Mandated Reporter training every two years. All staff receive the Measles, Pertussis, and Influenza vaccinations.
LPA reviewed 4 children's records, complete with the parent’s signature.
Staffing Ration and Capacity: Teacher-child ratios were observed, and staff names were recorded. Care and supervision were evaluated to determine if children's basic needs were met and appropriate.
Lead Testing: According to the director, she is not sure the center conducted drinking water testing for lead contamination. She will follow up with the office.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 09/03/2024
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Food Service: The facility currently has a food program. Meals such as an AM snack, an PM snack. The food is from school cafeteria kitchen. LPA observed the food menu. The kitchen is off limits to preschool children. Cleaning supplies were stored in a closet that is inaccessible to children.

The following general information was discussed during this inspection:
Immunization Requirements: §1596.7995 (a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a daycare 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 online 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.
Fingerprint clearances and transfers: Before working or volunteering in a licensed childcare 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
**Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed childcare facility are aware of situations that present the greatest danger to children
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 09/03/2024
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**Center Director advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation (call within 24 hours and submit a written report within 7 days) and on the form LIC624. The Center reminded to review updates/regulations as well as quarterly updates on the Department website. The "Notification of Parent's Rights" poster must be posted in an area of the center accessible to parents. The information regarding new legislation with regard to exemptions and parents' rights was also discussed.
Criminal Record Clearance - Child Care Centers Licensee [or 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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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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: PEARBLOSSOM ELEMENTARY SCHOOL
FACILITY NUMBER: 197750068
VISIT DATE: 09/03/2024
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For the following scenarios use the below un-bolded language: • CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING LEAD EXCEEDANCES, or • CCC COMPLETED SAMPLING BUT THE TEST RESULTS ARE NOT YET AVAILABLE, or • CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE, or • CCC TESTING DEADLINE HAS NOT PAST LPA referred licensee [or facility representative] to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.
Incidental Medical Services (IMS) - Child Care Centers IF A FACILITY IS CURRENTLY PROVIDING IMS, USE AS FOLLOWS: 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 PIN 22-02-CCP. 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-carecenters/.
MyChildCarePlan.org – Centers and Family Child Care Homes Licensee [or 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.
Notice of Site Visit - Centers and Family Child Care Homes A notice of site visit was given and must remain posted for 30 days.

No deficiencies are being cited at this time; the facility complies with Title 22

An exit interview was conducted, and the report was reviewed with the facility instructor, Christina Knott.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024
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