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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360900458
Report Date: 08/15/2024
Date Signed: 08/15/2024 04:06:11 PM

Document Has Been Signed on 08/15/2024 04:06 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:HESPERIA COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
360900458
ADMINISTRATOR/
DIRECTOR:
JACQUELYN MANSFIELDFACILITY TYPE:
850
ADDRESS:16775 OLIVE STREETTELEPHONE:
(760) 244-6164
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 67TOTAL ENROLLED CHILDREN: 67CENSUS: 57DATE:
08/15/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Jacquelyn MansfieldTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with the facility Director Jacquelyn Mansfield for the purpose of conducting a Annual/Random inspection. LPA toured and inspected the preschool in accordance with the facility sketch. LPA observed 57 children upon arrival. Present are 8 Teachers, 2 Aide on the premises along with the director. Currently center is utilizing rooms #20, 21, 23 and 42. The center operates 6:00am - 6:00pm, Monday through Friday. Incidental Medical Services (IMS) policy was discussed.

Furniture and equipment were inspected for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate.There are cubbies for children's belongings. LPA observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water disposable cups and water fountain (at entrance). Children also bring their own water bottle. There is also a water fountain on the play ground.. LPA observed a sufficient quantity of mats available for napping children. The bedding is stored separately and properly. The sheets are sent home weekly (Friday) and returned on Monday. Mats are sanitized weekly (Friday). There is a fire extinguisher, smoke detector and a carbon monoxide detector on the premises. LPA inspected and observed 5 clean bathroom (7 toilets, 7 sinks). Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available.

Teacher child ratios were observed and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.Personal rights of children were discussed. First Aid Kit in each classroom. Sign in and out sheets were reviewed. The parent board was reviewed and has all the required forms posted. Fire/earthquake drills current (03/04/2024). Roster current, Children and staff records were reviewed. LPA verified there is at least 1 staff person present with current CPR and First Aid Training current and Mandated Reporter current until 11/12/2025
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 08/15/2024 04:06 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 08/15/2024 at 02:42 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: HESPERIA COMMUNITY CHURCH PRESCHOOL

FACILITY NUMBER: 360900458

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/15/2024

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)],Staff #1 and Staff #2 immunization record are not on file, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2024
Plan of Correction
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The facility will submit proof of completion by due date
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review),Staff #1 and Staff #2 health screening form/TB clearance are not on file ], the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2024
Plan of Correction
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The Facility will submit proof of completion by due date.
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:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 08/15/2024
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Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered at the facility only with doctor permission on the required center form. There is a separate area for isolation and care of ill children at Director office.

Outdoor play equipment was inspected for health, safety, cushioning material (sand), good repair and age appropriate. The play area has sand and concrete. The area was observed to be free of debris. There is an area for shade and rest.There is a water fountain. Play area (slide, climber, sand, cement, swings, shed with key lock, shade) was inspected and found to be free of hazards and inaccessibility to bodies of water. Separate play area (gated) for ages 2-3- and 4–5-year-old children. There are Little Tikes play equipment and a large swing set that anchored.

There is a small kitchen area used by staff located in room #21.Kitchen has a microwave and refrigerator/freezer. Chemicals (locked) and food are kept in separate cabinets. Center provides AM, PM snack and does not provide breakfast. Parents bring lunch for children and breakfast. Trash cans have a lid (tight fitting). Menus are posted in the classrooms and kitchen. Allergy lists are posted in kitchen and classroom.LPA observed Snacks during the inspection.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.

Health-Related Services: The Director has been advised all prescription and non-prescription medications must have the child’s name and are dated, written consent and instruction from the child’s representative, and a plan to document and report to the child’s representative when medication is administered to a child; Medication will be properly labeled and stored in its original container. The IMS plan was discussed, and the Director understands when IMS is necessary

The Director 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: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 08/15/2024
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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 the publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The facility representative was informed of the MyChildCarePlan.org website, a consumer education website that helps families obtain childcare by connecting them to childcare 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 in 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 the date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. The 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 Hotline 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 platforms. 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

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HESPERIA COMMUNITY CHURCH PRESCHOOL
FACILITY NUMBER: 360900458
VISIT DATE: 08/15/2024
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The director advised of the requirement to report Unusual Incidents. The licensee was informed to utilize the Unusual Incident Report/Injury Report LIC624B when submitting the report to the department (email address on the website: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of the daycare center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. An On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8 am-5 pm.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The director shall permit the Department to inspect the family child care home and 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.

Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Deficiency cited today See LIC 809D.

An exit interview was conducted and the report was reviewed with the Director Jacquelyn Mansfield

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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