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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750178
Report Date: 02/20/2025
Date Signed: 02/20/2025 02:00:22 PM

Document Has Been Signed on 02/20/2025 02:00 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:BOUQUET CANYON EARLY LEARNING ACADEMYFACILITY NUMBER:
197750178
ADMINISTRATOR/
DIRECTOR:
CHERYL CAMERONFACILITY TYPE:
860
ADDRESS:28110 WELLSTON DRIVETELEPHONE:
(661) 294-5300
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 41DATE:
02/20/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Diana Gonzalez, Assistant Director Ruby Ramirez, Administrator Secretary, Kelsey Levy, Special Education Program Specialist TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On Thursday, February 20, 2025, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with Diana Gonzalez, Assistant Director Ruby Ramirez, Administrator Secretary, Kelsey Levy, Special Education Program Specialist who guided LPA Rivera on a tour of the facility.

This is a preschool program half day AM/PM that serves children ages 3 to 4 years. This program operates Monday to Friday 8:30 a.m. – 11:30a.m and Monday, Tuesday, and Thursday 12:30 pm-2:30pm. Sign in and out takes place at the classrooms entrance area. All areas identified on the facility sketch were toured and inspected both indoors and outdoors. Teacher and child ratio were observed, and present staff are fingerprinted cleared and at least one present staff has the pediatric first aid/CPR certification. Annual fee is current.



LPA entered classroom 25. LPA Rivera did not observe children in the classroom. The children were outside playing. LPA observed 20 children outdoor with staff #1, staff #3, staff #7 and staff #8 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 a cubby for children to store their personal belongings. LPA observed cleaning solutions stored inside the sink cabinet with a key lock making it inaccessible for children and open. LPA Rivera observed a trash bin with a lid.

LPA entered classroom 23/24. LPA Rivera observed 21 children with staff #2, staff #4, staff #5 and staff #6 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 a cubby for children to store their personal belongings. LPA observed cleaning solutions stored inside the sink cabinet with a key lock making it inaccessible for children to open. LPA Rivera observed a trash bin with a lid.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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: BOUQUET CANYON EARLY LEARNING ACADEMY
FACILITY NUMBER: 197750178
VISIT DATE: 02/20/2025
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Heating, lighting, and ventilation were evaluated by LPA Rivera. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostats located in classrooms 23/24 and 25 and temperatures to be 68 degrees. LPA observed the required 2A10BC fire extinguisher located in the classrooms with the valve on the green area indicating fully charged and serviced on 7/11/2024. Smoke detectors were not tested during this visit due to the detectors being wired to the emergency pull down fire alarm system. Carbon monoxide detectors in classroom 23/24 and 25. LPA Rivera tested and heard the sound and are operable. The last emergency drill was conducted on 2/20/25.

LPA did not observe napping equipment because this is a half day program. First aid kits supplies are kept inside the classrooms and nurse office. During this visit, per assistant director Diana, stated currently has children with medication. LPA observed Epi Pen with expiration date 6/2026, Epi Pen with expiration date 07/2025, Epi Pen with expiration date 9/30/2025, Benadryl with expiration date 3/2027, Benadryl with expiration date 05/2025, children allergy syrup with expiration date 7/2026, children allergy syrup with expiration date 4/2025 and Albuterol 1/22/2026. The medication is stored in the main office.

LPA Rivera asked Assistant Director Ruby if there were any poisons, firearms, weapons, or bodies of water. Assistant Director Ruby stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Assistant Director Ruby stated the ill isolation area takes place in the nurse’s office and utilize the staff restroom.

The restrooms are located next to the playground and both classrooms share restrooms LPA Rivera observed the restrooms to be in good condition with working toilets, urinals, sinks, hand soap dispenser and paper towels. LPA observed a total of 6 toilets, 2 urinals and 4 hand washing sinks.

LPA Rivera entered the outdoor play area. 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 for ages 2-12 years and areas around or under high climbing equipment, are cushioned with granulated rubber mat that may absorb a fall. For adequate shade, LPA Rivera observed a hip roof shade structure. LPA observed the playground yard to be fenced and the side gates closed and locked with a keypad lock. LPA observed 1 trash bin with tight lid. For outdoor water drinking, children utilize the water fountain.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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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: BOUQUET CANYON EARLY LEARNING ACADEMY
FACILITY NUMBER: 197750178
VISIT DATE: 02/20/2025
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This program provides snacks. The snacks are provided from an outside vendor Santa Clarita School Cafe. LPA Rivera informed Assistant Director Ruby 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 children with their water bottles and to refill their water bottle, the outdoor water fountain is utilized. Lead testing was conducted on 3/14/2024 and no lead exceedance.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu posted on the bulletin board, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA Rivera observed sign in/out sheets and observed 41 signatures.

LPA Rivera reviewed the children’s roster, children’s files, and staff files. Due to staff being hired by Saugus School District, certain forms are located in the district office.



LPA Rivera observed staff # 6 Pediatric First Aid/CPR certification dated 1/12/2024. LPA informed Assistant Director Diana Gonzalez all staff are required to complete the Child Care Child Abuse Mandated Reporting training that is provided on www.mandatedreporterca.com
Items discussed during this visit:

1. The following items are prohibited 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.

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.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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: BOUQUET CANYON EARLY LEARNING ACADEMY
FACILITY NUMBER: 197750178
VISIT DATE: 02/20/2025
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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, Child Abuse Certification, MMR, TDAP, TB, influenza, or influenza declination.

11. 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).

Ruby Ramirez Administrator Secretary 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

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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: BOUQUET CANYON EARLY LEARNING ACADEMY
FACILITY NUMBER: 197750178
VISIT DATE: 02/20/2025
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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.

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/.

Ruby Ramirez Administrator Secretary 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.

On Technical Assistance was given during this visit. No deficiencies given during this visit.

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 Ruby Ramirez, Administrator Secretary.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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