364818021-8-17-2023-12-CC-BIBE-CUSU7S-20230817152026

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364818021
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:20:36 PM

Document Has Been Signed on 08/17/2023 03:20 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:	BALDY MESA STATE PRESCHOOL		FACILITY NUMBER:	364818021
ADMINISTRATOR:	KIMBERLY MARTIN		FACILITY TYPE:	850
ADDRESS:	10376 BALDY MESA ROAD		TELEPHONE:	(760) 868-6229
CITY:	PHELAN	STATE: CA	ZIP CODE:	92329
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 11	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Evelyn Yammoto		TIME COMPLETED:	03:33 PM

NARRATIVE

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Licensing Program Analyst (LPA) Babatunde Ibitoye met with lead teacher Evelyn Yammoto today for the purpose of conducting an unannounced Required 1 year Annual inspection. This State Preschool occupies k2. A tour of the facility was conducted, k 2 had 3 staff (3 teacher, with 11 children) . This State Preschool is held on the site of Baldy Mesa Elementary School in Phelen, the hours of operation are (2 sessions) Mon - Fri from 8:00 AM -11:00 and from 11:45am to 2:45. This preschool is closed for the summer from June 7 to August 14. There is a waiver on file for the Pre-school children to share the play yard, there is a staggered play yard schedule.

Indoor/Children’s Area: Child care center is clean, safe, sanitary, and in good repair; all indoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are kept free of obstruction; floors of the classroom has a surface that is safe and clean, cleaning compounds inaccessible, poisons locked, furniture/equipment is good condition, tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has individual permanent storage space ( individually labeled with name) for his/her clothing and personal belongings.

Trash cans for solid waste have tight-fitting lids and children bring drinking water in reusable cups from home and water is also provided by the facility. All materials and surfaces are toxic-free and inaccessible and there is no fireplace. Classroom has working carbon monoxide detectors, smoke detectors, and Fire Extinguishers (3A40BC). There is a working landline telephone on the premises.

Restrooms: The bathroom has 2 toilets and 2 sinks. The staff restroom is located next door to the office. LPA observed the bathrooms to be clean and sanitary, with soap, toilet paper and paper towels readily available. Toilets and sinks are functioning properly and age appropriate.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BALDY MESA STATE PRESCHOOL	FACILITY NUMBER: 364818021
	VISIT DATE: 08/17/2023

NARRATIVE

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Outdoor: Outdoor play equipment was inspected for health, safety, good repair and age appropriateness. Center utilizes artificial grass, turf under climbing structures for cushioning material and there is enough and adequate shade available. Large play equipment and climbing structures are securely anchored. The area was observed to be free of debris. Outside Drinking water is available in the form of a water fountain

Staff/Personnel Records: Designation of Responsibility observed, immunizations, TB clearance, mandated reporter training, health screening, criminal record statement, and a statement acknowledging suspected child abuse are available for review.

Facility Records: Roster, fire/disaster drill log last completed on 05/2023, CPR/First Aid for one staff Expired 09/10/2024. and mandated report training were reviewed and maintained current.

Posting Requirements: Failure to comply with posting requirements shall result in an immediate civil penalty. The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 394L), emergency disaster plan, and earthquake preparedness checklist.

Food Service: This school serves snacks only which are delivered from the cafeteria. Menus observed and posted.

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

Advisory/Other: First aid supplies are readily available in the office. There is an isolation area for children who become ill while in care located in the school’s office, the facility maintains a comfortable temperature at all times. Smoking is prohibited on the premises, and daily inspection for illness is conducted. Firearms/weapons are not allowed or stored on the premises. There are no pools or bodies of water on the premises.

Electrical outlets are inaccessible, there are no recalled or prohibited toys or sleep/play equipment were observed on the premises. There are no window cords accessible to children.

Sign-in and out sheets were reviewed. The parent board was reviewed and has all the required forms posted.

Teacher-child ratios were observed and staff names were recorded. Care and supervision were evaluated to determine if the basic needs of children are met and appropriate.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BALDY MESA STATE PRESCHOOL	FACILITY NUMBER: 364818021
	VISIT DATE: 08/17/2023

NARRATIVE

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Health-Related Services: Lead Teacher 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.

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. Center provide IMS as needed by the school Nurse.

Lead Teacher advised of the requirement to report Unusual Incidents. 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.

A survey will be sent to the email address provided to improve the quality and value of the new inspection process. 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/process

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: BALDY MESA STATE PRESCHOOL	FACILITY NUMBER: 364818021
	VISIT DATE: 08/17/2023

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 26 27 28 29 30 31 32	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. No deficiency was cited today. LPA Issued 1 Technical assistance for Mandated Reporter Training. An exit interview was conducted and the report was reviewed with the Lead Teacher Evelyn Yamamoto

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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