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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 267750000
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:08:31 PM

Document Has Been Signed on 10/23/2024 02:08 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:LITTLE LUPINS/MAMMOTH HOSPITALFACILITY NUMBER:
267750000
ADMINISTRATOR/
DIRECTOR:		BRITTANY NELSONFACILITY TYPE:
850
ADDRESS:379 OLD MAMMOTH ROADTELEPHONE:
(760) 923-8344
CITY:MAMMOTH LAKESSTATE: CAZIP CODE:
93546
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 10DATE:
10/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:34 AM
MET WITH:Daniela Delgado Ramirez, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 10/23/2024, Licensing Program Analyst (LPA) Crystal Ali arrived at the facility to conduct an Annual Random Inspection. Facility is located in the Mammoth Lakes Lutheran Church downstairs. LPA was met by Daniela Delgado Ramirez, Program Manager and permitted to enter the facility. LPA toured the facility in accordance with the facility sketch with Daniela. During the inspection, LPA observed 10 children and 3 teachers providing care and supervision. Facility operates Monday through Friday from 7:45am to 5:15pm. In the winter schedule changes to 7:45am-4:45pm, starting 11/01/2024.
Staffing Ration and Capacity: Facility consists of one large classroom, one staff bathroom, one children’s bathroom, kitchen, two storage closets (safety knobs on doors), and one outdoor play area (adjacent for the preschool). Facility maintains an adequate teacher-child ratio. Care and supervision were evaluated and determined basic needs of children are appropriate and are being met.
Physical Plant: 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 via Brightwheel App. LPA observed individual storage for children's belongings. The children have access to filtered water via individual water bottles.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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 Smoke detectors, carbon monoxide detectors, and fire extinguishers were observed and in operable condition per Fire Marshall standards. Program Manager stated that fire marshall has not come since they were originally licensed in 2022. First Aid Kit is missing tweezers. Program manager stated they will purchase tweezers. Trash cans with tight fitted lids were observed.
Napping: Children are provided napping daily from 12pm-2:15pm. Children are provided cots to sleep on during nap time. Napping materials are cleaned at the end of each week.
Kitchen: The kitchen is inaccessible to children. There is a clean, fully equipped kitchen with a refrigerator, freezer, oven and microwave. The facility provides morning snack and water to the children. There is outside food allowed via children bringing their own lunches. Lunch boxes are located on the shelf located on the side of the kitchen in reach for children. If lunch boxes (with child name present) need to be refrigerated, teachers will ensure to store them in refrigerator. Allergy lists are posted in the kitchen (on refrigerator) and in their record file. Program manager states there are no children with food allergies. LPA observed an appropriate amount of snacks and staff preparing snacks (with gloves). Chemicals, soaps, detergents, cleaning compounds, or similar substances are stored separately from food supplies and located in the kitchen under the sink and above the sink with safety latches present. The knives are located in the middle drawer of the large kitchen counter, safety latched. LPA observed that food preparation and storage areas are kept clean and free of litter and rubbish. Snack menus are posted at least one week in advance and made available for review by the parents. The facility does not participate in the food program. Daily activity schedules are posted showing meals/snack times, and specific activities. LPA observed some snack items without the date received marked on the package.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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Fire Extinguisher: Emergency Drills are conducted at least every six months and the last drills were conducted and documented on 2/15/24. Program manager stated they are behind on this and will conduct emergency drills this month. The two fire extinguishers (3A40BC) are reading in green and meets the Fire Marshall Codes and Standards, Fire extinguishers were last serviced 5/11/24. One fire extinguisher is located at the entrance of preschool and the second is located side emergency entrance to the left.
Bathroom: Age-appropriate sinks and toilets were inspected for availability and good repair. Girls and boys share the bathroom with teacher supervision. There are three sinks reachable by the children and two toilets that flush properly. There is a changing table located across from the third sink. There are two potty training toilets for those children who are potty training. Each restroom has adequate toilet paper, diapers, pull ups, hand soap, and paper towels available. Restrooms are cleaned, restocked with toiletries, and sanitized by on-site staff.
Medication: A review of medication policy indicated that prescription medication is administered only with the parent’s written permission. The facility teachers pass out medication. Medication is labeled correctly and stored in its original container. Currently one child is on medication. LPA observed the required documentation for passing and storing this child medication. The medication is located in the top right cabinet locked next to microwave, inaccessible to children. Children are inspected for illnesses as they arrive with a no-touch thermometer and an overall wellness check. Isolation area is in the calm corner away from rest of the children where a teacher will remain with the child until the parent comes. There are currently no children in care with IMS needs.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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Transportation: The facility does not provide transportation for the children. Teachers do take field trips that are walking distance from the preschool with parent permission. Fields include library and local park.
Lead Testing/Drinking Water: The facility has not completed lead testing. Program manager stated that they will provide filtered water for all the children to drink. LPA provided a copy of the PIN letter that was sent out for centers to complete lead water testing.
Outdoor Activity Space: The outdoor play area was inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair, and age appropriateness. Play yard is located adjacent to the preschool. Teachers walk over with the children to the play yard. Play yard has a small play equipment with a slide. There are three small tables, two sandboxes, and other outdoor toys. The preschool will continue to provide 100% supervision when outside in the playground. Children are provided filtered water via individual drinking bottles at the water station. 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. Play yard is cleaned once a week for debris as there is no stray animals around. The play yard has artificial grass. There is a locked shed in the play yard area for storage of tools.
Records/Documentation: LPA reviewed with facility representative the LIC 125, records to be maintained at the facility, for child’s records, personnel records, administrative records, and parent board. Employee records are not incompliance. There are two employees with expired mandated reporter training. Child records are in compliance. LPA observed that one child file that requires and updated emergency form (LIC 700/702) due to health improving.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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Deficiencies cited: Three Type B’s cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

A notice of site visit was given and must remain posted for 30 days. A copy of this report and copy of appeal rights were provided to facility representative.



Exit interview conducted and report was reviewed with the Program Manager, Daniela Delgado Ramirez.

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.

Criminal Record Clearance - Child Care Centers
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.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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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.
Safe Sleep - Child Care Centers
LPA discussed the safe sleep regulations with facility representative and
discussed the Child Care Licensing Safe Sleep web page at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed facility
of the importance of checking for recalled infant devices on the United States
Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and
recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000
VISIT DATE: 10/23/2024
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Incidental Medical Services (IMS) - Child Care Centers
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/.
PIN 22-05-CCP.
MyChildCarePlan.org – Child Care Centers
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.
Subscribe to CCLD important information - Child Care Centers
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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/
subscribe and select the Child Care option to receive email communication.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/23/2024 02:08 PM - It Cannot Be Edited


Created By: Crystal Ali On 10/23/2024 at 01:39 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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

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 in completing lead water testing for the preschool which poses/posed a potential health, safety or personal rights risk to persons in care. Preschool will only provide filter water for drinking and cooking until lead water testing is completed and approved by LPA.
POC Due Date: 11/05/2024
Plan of Correction
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Program Manager will provide proof of completion to LPA.
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

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 in completing disaster drill within 6 months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/24/2024
Plan of Correction
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Program Manager will provide proof of completion to LPA.
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:Claretta Yates
LICENSING EVALUATOR NAME:Crystal Ali
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/23/2024 02:08 PM - It Cannot Be Edited


Created By: Crystal Ali On 10/23/2024 at 01:39 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: LITTLE LUPINS/MAMMOTH HOSPITAL
FACILITY NUMBER: 267750000

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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 in completing mandated reporter training for two employees which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/29/2024
Plan of Correction
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Program Manager will provide proof of completion to LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Claretta Yates
LICENSING EVALUATOR NAME:Crystal Ali
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024


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