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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805430
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:32:26 PM

Document Has Been Signed on 09/29/2023 02:32 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:MT. CALVARY KIDS CORNERFACILITY NUMBER:
364805430
ADMINISTRATOR:VICKEY ENGLANDFACILITY TYPE:
850
ADDRESS:32054 HUNSAKER WAYTELEPHONE:
(909) 867-7228
CITY:RUNNING SPRINGSSTATE: CAZIP CODE:
92382
CAPACITY: 49TOTAL ENROLLED CHILDREN: 30CENSUS: 13DATE:
09/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Facility Representative Vickey England TIME COMPLETED:
12:30 PM
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On September 29, 2023, at 08:25 a.m. Licensing Program Analyst (LPA) Kendal Zirbes met with Facility Representative Vickey England. The purpose of the inspection was to conduct a required one year inspection at the licensed facility. LPA disclosed the purpose of the inspection to the facility representative. Present during today’s inspection were 13 preschool children, and four teachers.
The preschool program is operated out of three classrooms (Classroom One "Busy Bees" serves 4-5 year old children, Classroom Two "Tadpoles" serves 2-3 year old children, and Classroom Three "Sock Monkeys" serves 3-4 year old children) The center also operates a School Age Program (#364805431). The Center shares a kitchen, staff restrooms, staff break/ office and storage space with the other licensed component. The facility operates Monday through Friday 7:00am -6:00pm.
Indoor area: Child care center was observed to be clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction; floors of all rooms have a surface that is safe and clean. Cleaning compounds were stored in the staff bathroom which was equipped with a child safety latch. In addition, disinfecting wipes were located in high inaccessible shelves in the classrooms. Per Administrator, zero poisons are stored within the preschool. LPA observed the furniture/equipment is in good condition. Classroom was free of flies, other insects and rodents. The classrooms had tables and chairs to meet the children's needs. LPA observed the Center has a variety of art supplies, dramatic play equipment, blocks, books and a wide variety of additional educational materials. Children's belongings are kept in cubbies labeled with the children's names. Trash cans for solid waste have tight fitting lids. Drinking water is readily available indoors via personal water bottles. The water bottles are filled with water from the classroom sinks. All materials and surfaces are toxic free, window screens in good repair and free of debris. There are carbon monoxide detectors, smoke detectors and multiple fire extinguishers located throughout the Center. The Center had working telephone service on the premises. There is an isolation area for children who become ill while in care. The facility maintains a comfortable temperature at all times. Report continued on page two
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MT. CALVARY KIDS CORNER
FACILITY NUMBER: 364805430
VISIT DATE: 09/29/2023
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Report continued from page one

LPA observed the centers sign in/out sheets, which are completed daily. Smoking is prohibited on the premises. LPA did not observe prohibited childcare items during this inspection.
Firearms/weapons are not allowed or stored on premises. LPA did not observe bodies of water on the premises.

Napping: LPA observed cots for the children. LPA observed the children's blankets/sheets are stored in individual bags labeled with the children's names. The Center washes all bedding on site

Restrooms: There are a total of three restrooms in the preschool. Classroom One had two restrooms. One restroom had two toilets and the other restroom had one toilet. The third restroom is located between Classroom One and Classroom Three. This restroom had two toilets. Hand washing sinks were located in each classroom. Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available. LPA observed, one toilet tank lid had two cracks on the right side. One crack was arched and was approximately 2 inches long the second crack was approximately three inches long. The Center had attempted to repair the cracks with glue. Per Administrator the facility has attempted to replace the lid however finding the correct size has been challenging. Administrator stated the toilet tank cover will be replaced within the week. Documentation showing the lid has been replaced will be submitted to the Department. This toilet was utilized by classroom Two and Three. Classroom 2 was equipped with a diaper changing table. There is an additional restroom for the staff.

Kitchen: The center has a kitchen. Per Administrator the kitchen is not being utilized at this time. The kitchen was inaccessible to the children via a locked half door.

Food Service: The families provide all meals and snacks for the preschool children.

Outdoor
LPA inspected the outdoor play space for health, safety, cushioning material, good repair and age appropriateness. The Center has two outdoor play spaces. One play space is utilized for preschool children. The space contained a climbing structure. Report continued on page three
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
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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: MT. CALVARY KIDS CORNER
FACILITY NUMBER: 364805430
VISIT DATE: 09/29/2023
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Outdoor continued: The climbing structure was placed on recycled rubber and was anchored to the ground. The second outdoor play space is utilized for 4-5's year olds and school age children. An approved waiver is on file. The outdoor space had a large climbing structure, dramatic play house, art supplies and sand box. The climbing structure was placed on recycled rubber and was anchored to the ground. At the time of this inspection, the recycled rubber under the climbing structures was approximately one inch deep. LPA advised the Center to monitor the depth of the recycled rubber to ensure the cushioning material is a depth that can absorb falls. Furthermore, LPA observed the exit area for the green slide and the grey climbing structure were within six feet of each other. LPA advised the facility representative that staff should be providing active supervision in this area the two activities are within close proximity to each other.
Water is accessible to the children via water bottles brought from home. Each of the outdoor play spaces are fully enclosed by a chain link fence.
Staff/Child Records
LPA reviewed five child files and four staff files. Based on LPA review, child files were complete and contained all required information. Based on LPA review, two of four staff files review did not have current mandated reporter training on file, therefore a type B citation was issued, refer to LIC 809D. In addition, based on LPA review, Staff 1 started on 8/10/23. S1 did not have a health screening or a test for tuberculosis completed not more than one year prior or seven days after employment. A technical advisory notice was issued. A staff member was on site who had a current CPR/First Aid.
Facility Records
LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.
Per conversation with facility representative the required testing has not been completed yet however the facility has reached out to a Lead testing company. The Lead testing has not occurred due to a few faucets with small leaks. Per Administrator, the building was constructed prior to 1/1/2010. Based on interviews, the center did not have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023. Therefore a type B citation was issued, refer to LIC 809D.
Posting Requirements: The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), car seat law (PUB 269), emergency disaster plan, earthquake preparedness checklist. LPA reminded the center representative that failure to comply with posting requirements shall result in an immediate civil penalty of $100. Report continued on page four
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
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: MT. CALVARY KIDS CORNER
FACILITY NUMBER: 364805430
VISIT DATE: 09/29/2023
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Health Related Services
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

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Center shall permit the Department to inspect the child care center and to privately interview children or staff, to determine compliance with or to prevent violations of child care laws 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.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (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 center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Report continued on page five
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/29/2023 02:32 PM - It Cannot Be Edited


Created By: Kendal Zirbes On 09/29/2023 at 11:43 AM
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: MT. CALVARY KIDS CORNER
FACILITY NUMBER: 364805430

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2023

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 interview and record review, the licensee did not comply with the section cited above when the child care center was not tested for lead contamination between 1/1/2020 and 1/1/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2023
Plan of Correction
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Per Administrator, the required lead testing will be scheduled 10/16/2023. An email will be submitted to the Department verifying the lead testing inspection has been scheduled.
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 record review, the licensee did not comply with the section cited above in two of four staff files did not complete the mandated reporter training as required, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2023
Plan of Correction
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Per Administrator, the staff will complete the mandated reporter training, a copy of the training certificate will be submitted to the Department. Administrator stated a system will be created which sends a reminder to the staff that the trainig is expiring in the next 10 days.
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:Lady King
LICENSING EVALUATOR NAME:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023


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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: MT. CALVARY KIDS CORNER
FACILITY NUMBER: 364805430
VISIT DATE: 09/29/2023
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Report continued from page four

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 license 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Based on LPA record review, two type B citations and three advisory notices were issued. Refer to LIC 809D.

A 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. Exit interview conducted and report was reviewed with the facility representative Vickey England.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
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