364805431-9-29-2023-12-CC-KZIS-CW5TAT-20230929143403

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364805431
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:34:15 PM

Document Has Been Signed on 09/29/2023 02:34 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 CORNER		FACILITY NUMBER:	364805431
ADMINISTRATOR:	VICKEY ENGLAND		FACILITY TYPE:	840
ADDRESS:	32054 HUNSAKER WAY		TELEPHONE:	(909) 867-7228
CITY:	RUNNING SPRINGS	STATE: CA	ZIP CODE:	92382
CAPACITY: 19	TOTAL ENROLLED CHILDREN: 16	CENSUS: 11	DATE:	09/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Administrator Vickey England		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On September 29, 2023, at 12:31 p.m. Licensing Program Analyst (LPA) Kendal Zirbes met with Administrator 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 Administrator. Present during today’s inspection were 11 school age children, one teacher and additional staff members. The school age program is operated out of one classroom. The center also operates a Preschool Program (#364805430). The Center shares a kitchen, staff restroom, staff office and storage space with the other licensed component. The facility operates Monday through Friday 7:00am -6:00pm. Indoor/Children's Area: Indoor activity space for school age children is physically separate from space used by children in the preschool component. School age center is equipped with appropriate furniture and equipment. LPA observed a dramatic play area, library, board games and art supplies. Furniture is maintained in good repair, safe condition and was age appropriate. Drinking water is available inside the classroom via water bottles brought from the children's home. The water bottles are filled up utilizing the classroom sinks. Each school age child has an individual cubby labeled with their name for the storage of personal items. Trash cans for solid waste have tight fitting lids. 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. LPA observed the centers sign in/out sheets, which are completed daily. Sign in and out sheets document when the children return to the Center from school. 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. 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: 364805431
	VISIT DATE: 09/29/2023

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Restrooms: There are two restrooms located in the school age classroom. Each restroom had one toilet. Hand washing sinks were located outside of the restrooms. Toilets and sinks are functioning properly and are age appropriate. LPA observed soap, toilet paper and paper towels readily available.

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: One afternoon snack is provided to the school age 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 the preschool children. 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, as 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 two staff files. Based on LPA review, child files were complete and contained all required information. Based on LPA review, one of the two staff files was missing documentation of the measles and pertussis immunization, a technical violation was issued.
A staff member was on site who had a current CPR/First Aid.
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

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: 364805431
	VISIT DATE: 09/29/2023

NARRATIVE

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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.

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.

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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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: 364805431
	VISIT DATE: 09/29/2023

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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, one type B citation and one 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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Document Has Been Signed on 09/29/2023 02:34 PM - It Cannot Be Edited

Created By: Kendal Zirbes On 09/29/2023 at 01:23 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: MT. CALVARY KIDS CORNER	FACILITY NUMBER: 364805431
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
1 2 3 4	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
1 2 3 4	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.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

LIC809 (FAS) - (06/04)

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