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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750142
Report Date: 09/01/2022
Date Signed: 09/01/2022 04:14:22 PM

Document Has Been Signed on 09/01/2022 04:14 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:WOODEN SHOE PRESCHOOLFACILITY NUMBER:
197750142
ADMINISTRATOR:MARTHA T VELOZFACILITY TYPE:
850
ADDRESS:1525 GLENOAKS BLVDTELEPHONE:
(818) 365-1513
CITY:SAN FERNANDOSTATE: CAZIP CODE:
91340
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 23DATE:
09/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Martha Veloz, DirectorTIME COMPLETED:
03:03 PM
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Licensing Program Analyst (LPA) Maddox met with Martha Veloz, Director today for the purpose of conducting a Pre-Licensing for a Change of Ownership inspection. LPA toured and inspected all areas according to the facility sketch (5 classrooms and outside play area). This Pre-School program is held on the campus of Glenoaks Elementary School and occupies the following classrooms: 21B; 22A & 22B; 23A & 23B. The hours of operation are MONDAY - FRIDAY 7:00 AM - 6:00 pm.

**LPA noted age appropriate furniture, equipment, toys and materials. Classrooms were 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. Children bring their own water containers, also each classroom has a drinking fountain.

**The children's bathrooms are located in between classrooms.
The staff restroom is located in the main office, this bathroom will also serve as an isolation bathroom. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate.

Napping: There are rubber maid containers available for children's linens. Cots used are maintained in good condition, wiped/cleaned/disinfected weekly or when soiled, no contact with other children bedding.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 09/01/2022
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Applicant was reminded of the requirement to report and unusual incidents and/or injuries to the parent/guardian and Licensing within the time frame specified by the regulation and on the form LIC 624B.

**OUTDOOR AREA:

The facility has 2 playground areas. The preschool children play in a gated area separated by a fence. On the other side of the play area is another play area for the preschool children. Outside play area is completely fenced. 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, free from hazard, holes, broken items, cushioning material underneath. No bodies of water were observed. There are areas for shade and rest. Children use their personal water bottles for outside play.


**LPA observed working smoke detectors, fire extinguishers, and carbon monoxide detectors throughout center. Applicant was informed to keep a log of Emergency fire/Disaster drills; sign in and out sheets contain full legal signatures; License is posted along with other forms that require posting after licensure.

**FOOD SERVICE: Children have the option of bringing their own lunches or they may participate in the centers Food Program. Food preparation area/Kitchen was inspected for safety, cleanliness, proper equipment & protection against contamination and storage, menus observed and posted.


SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 09/01/2022
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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 - Center provides IMS

**Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). In addition; all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report documenting a Type A Citation and sign form LIC 9224 acknowledging receipt. Staff are aware of required forms for children's

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to privately interview children or staff, to determine compliance with or to prevent violations of child care center or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.

MEASUREMENTS WERE AS FOLLOWS:

Room #21: 524 sq ft/35 = 15 C


Room #22A: 614 sq ft/ 35= 17 C
Room #22B: 850 sq ft/35 = 24 C
Room 23A: 838 sq ft/35 = 24 C
Room 23B: 860 sq ft/35 = 25 C
Total Capacity with Indoor Measurements is 105
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 09/01/2022
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OUTDOOR MEASUREMENTS:

The outside play yard is divided into 2 yards:


Play Yard A: 2,856/75 = 38
Play Yard B: 2,520/75 = 34
Total Capacity with Outdoor Measurements is 72

BATHROOMS:

Room 21B has 1 bathroom is 1 toilet and 1 sink/ 15C


Room 22A & 22B have a bathroom in between the classes, the bathroom has 2 toilets and 1 sink inside with an additional sink directly outside the bathroom. Equates to 30 C
Room 23A and 23B have a bathroom in between the classes, the bathroom has 2 toilets and 1 sink inside with an additional sink directly outside the bathroom. Equates to 30 C
Total Capacity with bathrooms is 75

Fire Clearance received for the Requested Capacity of 74

Medications are stored in Emergency back packs within the classrooms inaccessible to children.

Lead testing took place on 8/26/22

Applicant was informed an On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm. Exit interview conducted and report was reviewed with Director Martha Veloz This report was read and provided to Director Martha Veloz.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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