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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750142
Report Date: 01/04/2024
Date Signed: 01/04/2024 03:01:32 PM

Document Has Been Signed on 01/04/2024 03:01 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: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: 19DATE:
01/04/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director Martha VelozTIME COMPLETED:
03:15 PM
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On 1/4/2024 at 9:30am, Licensing Program Analyst (LPA) Andrea Pittman arrived at the facility to conduct an Annual Random Inspection. LPA was met by Facility Representative and permitted to enter the facility. The Director Martha Veloz guided the LPA on a tour of the facility in accordance with the facility sketch. During the inspection, LPA observed 10 children and 5 staff providing care and supervision. Facility operates Monday through Friday from 7:00am to 6:00pm.

Facility consists of a total of 11 rooms/areas: five classroom, one office, one kitchen, one staff restroom, two children’s restroom, and one outdoor play area.

Indoor Activity Space:
There are five classrooms in total but only three classrooms are being used for child care purposes. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated. LPA observed sign-in sheets completed by each parent/guardian per requirements. LPA observed individual storage for children's belongings. Children are provided bottled water dispensed in individual water bottles or their personal water bottles. An isolation area was inspected in the office and located near a separate staff restroom which is separate from the healthy children’s restroom. The calming area was inspected and located near the door in all of the classrooms. Children are provided napping and age appropriate and individual bedding were observed; the facility had 67 cots for napping purposes but is aware that there should be enough for the enrolled capacity. Age-appropriate sinks and toilets were inspected for availability and good repair. Toilets flushed 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 with toiletries, and sanitized by on-site staff.

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 01/04/2024
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Smoke detectors, carbon monoxide detectors, fire pull system, and fire extinguishers were observed and in operable condition and are operating according to Fire Marshall standards. LPA observed the first aid kit and it was found to be complete with the following supplies including tweezers, scissors, adhesive tape, gauze, bandages, cleansing pad/solution, thermometer, and a first aid manual. Trash cans with tight lids were observed making solid wastes inaccessible to children in care. Cleaning supplies, hazardous materials, and/or poisons are found to be out of the reach of children and placed in high cabinets unreachable by the children.

Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 12/13/2023 at 9:15am for the Emergency Drill. The fire extinguisher (2A10BC in all rooms but the third room had a 3A40BC) is reading in green and meets the Fire Marshal Codes and Standards (last serviced 11/21/2023). Daily activity schedules are posted showing meal/snack times, nap time, and specific activities. The parent board was reviewed and has all the required forms posted and accessible to parents. Food allergies are noted on a sheet and are posted in the classrooms. There is outside food permitted, if purchased from a business. The center does not provide meals as the children bring their meals from home but does have snacks available, when necessary, children meals are properly labeled. Menus are not required as the facility does not provide meals.



Outdoor Activity Space:
The outdoor play area was inspected for hazardous, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. At 10:20am, LPA observed during the walk through of the outdoor play area a playhouse that had been damaged, with sharp edges, and still in the play area. This is a Type B violation, see the LIC 809D for the details. LPA observed climbing structures and other play equipment were found to be securely anchored with adequate, resilient, cushioning material underneath and around the perimeter. Children are provided bottled water dispensed in individual water bottles or their personal water bottles during outdoor play. There is adequate shaded area for rest. The playground is well-fenced, all around and no bodies of water were observed in the outdoor play area.

Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 01/04/2024
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Records/Documentation:
Children's records were reviewed for completeness. LIC 702- Preadmission Health History, LIC 700- Identification & Emergency contact, and LIC 701- Physician Reports or similar documents used by the facility; Immunization Records and CDPH 286 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. Personnel records were reviewed for completeness. Director and teachers are currently certified in Pediatric CPR/First Aid, expiring in 2024. Child Care Providers (AB1207) Mandated Reporter training certificate is valid for the staff; however, Staff 1 completed the incorrect training, this is a Type B violation, see the LIC 809D for the details. Staff 2 has not received the MMR vaccine and there is no proof of immunity in their case file, this a Type B violation, see the LIC 809D for the details. Staff 3 has not completed the LIC 503 health screening prior to the start of employment, this is a Type B violation, see the LIC 809D for the details.

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.

Safe sleep was not discussed as there is no infant license at the facility.



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

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SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142
VISIT DATE: 01/04/2024
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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.

All staff are required to take 3-hour Child Care Provider Mandated Reporter training (AB1207) every 2 years. 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. Director is aware self and all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hot-line at (800) 540-4000.


For additional information and forms visit our website at: www.cdss.ca.gov

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


For updates on Community Care Licensing, please visit the following website at: Childcareadvocatesprogram@dss.ca.gov

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

Per Title 22 Regulations, this facility is not in compliance, four Type B Deficiencies have been cited. Please, see the LIC 809D for the citations. An exit interview conducted and report was reviewed with the Director Martha Veloz and a copy of this Report, a Notice of Site Visit, and Appeal Rights were provided on this day.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/04/2024 03:01 PM - It Cannot Be Edited


Created By: Andrea Pittman On 01/04/2024 at 02:17 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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

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 the section cited above by having a damaged playhouse with sharp edges in the outdoor play area which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2024
Plan of Correction
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The Director plans to send a picture of the playhouse placed in an inaccessible area via text no later than 1/18/2024.
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 the section cited above by Staff 1 not having completed the correct Mandated Reporter Training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/18/2024
Plan of Correction
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The Director will send proof of the completed Mandated Reporter Training for Staff 1 via e-mail no later than 1/18/2024.
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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/04/2024 03:01 PM - It Cannot Be Edited


Created By: Andrea Pittman On 01/04/2024 at 02:17 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: WOODEN SHOE PRESCHOOL
FACILITY NUMBER: 197750142

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(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.

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 the section cited above by not having Staff 2 take the MMR vaccine or show proof of immunity prior to employment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/05/2024
Plan of Correction
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The Director will send proof of the taken vaccine/immunity for Staff 2 no later than 2/5/2024
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

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 the section cited above by not having Staff 3 complete a health screening LIC 503 prior to starting employment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/05/2024
Plan of Correction
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The Director will send proof of the completed health screening LIC 503 for Staff 3 no later than 2/5/2024
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:Mariela Ramon
LICENSING EVALUATOR NAME:Andrea Pittman
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


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