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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 267750000
Report Date: 08/17/2022
Date Signed: 08/22/2022 10:14:27 AM

Document Has Been Signed on 08/22/2022 10:14 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:LITTLE LUPINS/MAMMOTH HOSPITALFACILITY NUMBER:
267750000
ADMINISTRATOR:BRITTANY NELSONFACILITY TYPE:
850
ADDRESS:379 OLD MAMMOTH ROADTELEPHONE:
(760) 923-8344
CITY:MAMMOTH LAKESSTATE: CAZIP CODE:
93546
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
08/17/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Brittany Nelson, Site Supervisor, Sarah Vigilante, Administrative Service Director, and Theadora Zobel, TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Maddox conducted an announced visit today and met with Brittany Nelson, Site Supervisor, Sarah Vigilante, Administrative Service Director, and Theadora Zobel, Teacher for the purpose of conducting a Pre-Licensing inspection for a Preschool component for children ages 2 - 5 yrs. The hours of operation will be: Mon - Fri from 7:45 am to 5:15 pm. Applicants are requesting to be licensed for 22 children. LPA toured the entire center which consist of 1 classroom, bathrooms, outside play yard, and the kitchen area. This center is located inside the Mammoth Lake Lutheran Church, downstairs (child gate in place).

INDOOR ACTIVITY SPACE:

· The child care center was toured and found to be clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors


· Floors of all rooms have a surface that is safe and clean
· A comfortable temperature for children shall always be maintained.
· Furniture and equipment are maintained in good condition, free of sharp, lose or pointed parts. There are a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 08/17/2022
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fully participate in planned activities.
· Tables and chairs were present to meet the needs of the children.
· Drinking water is readily available - dispenser with disposable cups and water bottles.
· Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children were stored and inaccessible to children. Stored above the sink in the kitchen in a locked cabinet (LPA observed child gates in place.
· LPA observed fully stocked first-aid kits, one in an upper cabinet in the kitchen and 1 back pack with first aid supplies, accessible to staff but inaccessible to children:
· The isolation is located teacher bathroom for any child who becomes ill during the day.
· LPA observed working carbon monoxide detectors and smoke detectors and fully charged fire extinguishers throughout the facility.
· The center has a working telephone
· There is a Sign-in and out book available at the entrance. rocedure -----
· The licensee shall conduct a wellness check to ensure that children with obvious symptoms of illness including, but not limited to, fever or vomiting, are not accepted.
OUTDOOR

Children will be escorted across the parking lot to the play yard, the entire play yard is fenced. There are large trees that provide natural shade, and the building also provides shade on the play yard as well. LPA observed a storage shed available for equipment.

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

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 08/17/2022
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 The play yard was free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. Drinking Water, staff will bring water out for the children, also water bottles are available.

· There are no bodies of water on the premises


RESTROOMS

There is 1 bathroom for designated for children, the bathroom has 2 toilets and 2 sinks and also a changing table. All toilets, hand washing and bathing facilities shall be maintained in safe and sanitary operating condition.

There is a separate Staff bathroom which is also designated as the isolation bathroom, a cot is also available.

SUPERVISION:

No child(ren) shall be left without the supervision of a teacher at any time, Supervision shall include visual observation.

TRANSPORTATION:

No transportation at this time.

CHILDREN’S RECORDS:


All children's records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. LPA gave applicant form LIC 311 to reference

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

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 08/17/2022
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NAPPING

· Cots used for napping were maintained in a safe condition.


· Each cot shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child.
· LPA informed applicants cots should be wiped with a detergent/disinfectant weekly or when soiled or wet.
· Bedding/Linen will be stored in cubbies located in the main area.

HEALTH RELATED SERVICES:

Medications will be kept in an above cabinet in the kitchen. There is a

refrigerator available for lunches and medications.

Applicants have implemented a written plan to record the administration of prescription medications.

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

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

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 08/17/2022
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FOOD SERVICES

Children will bring their own lunches, center will provide AM snacks.

· Pesticides and other similar toxic substances were not stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored. Soaps, detergents, cleaning compounds or similar substances were stored in areas separate from food supplies.


· The kitchen was toured and found to be free of litter and rubbish.
· The Trash can has a tight fitting lid in place.
· There is a refrigerator available to store any medication that requires refrigeration.

POSTINGS:

The licensee shall post signs at the entrance to the child care center that provide the telephone number of the local health department and information on child passenger restraint systems pursuant to Health and Safety Code section 1596.95(g) and Vehicle Code sections 27360 and 27360.5

Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available.

Applicants are aware 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.

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

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 08/17/2022
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Measurements were as follows:

Inside: 13 X 12 = 156/35 = 4
34 X 35 = 1190/35=34
Total indoor space: 38

Outside:
49 X 40 = 1960/75 = 26

Bathrooms:
2 toilets and 2 sinks = 30

Fire Clearance has been received for the requested capacity of 22.

Applicants are aware of required forms for staff and children.

Needed Prior to Licensure:

Brittany and Lead Teacher, Ms. Thea need to take the Operations and Records keeping Orientation, upon completion, the certificates will be forwarded and licensure will be approved.

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

DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022
LIC809 (FAS) - (06/04)
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