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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844174
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:59:11 AM

Document Has Been Signed on 08/26/2024 11:59 AM - 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:SBCSS LUCERNE VALLEY STATE PRESCHOOLFACILITY NUMBER:
364844174
ADMINISTRATOR/
DIRECTOR:		NANCY ALVARADOFACILITY TYPE:
850
ADDRESS:10788 BARSTOW ROAD ROOM EC3TELEPHONE:
(760) 248-1026
CITY:LUCERNE VALLEYSTATE: CAZIP CODE:
92356
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 6DATE:
08/26/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Phyllis Walker- Lead teacherTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 8/26/2024, Licensing Program Analyst (LPA) Sherell Braddock met with the facility Lead Teacher, Phyllis Walker for the One Year Required inspection for the preschool license in accordance with the facility sketch. A tour of the facility was conducted. Upon arrival LPA observed a total of 6 preschool children in 1 classroom (EC3). There was 1 assistant teacher on the premises along with the Lead Teacher. The hours of operation are Monday thru Friday (between 8:00 am – 11:00 AM and 11:45 AM - 2:45 PM. Incidental Medical Services (IMS) were discussed.

Indoor/Children’s Area:
Child care center is 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 inaccessible, poisons locked, furniture/equipment is good condition, free of flies, other insects, rodents; tables/chairs provided to meet children’s needs; all play equipment and materials used by children are age-appropriate, each child has an individual permanent or portable storage space (cubby, individually labelled with name) for his/her clothing, personal belongings and or bedding (stored separately). There is a working telephone.

Trash cans for solid waste have tight fitting lids, drinking water is readily available indoors and outdoors (water drinking jugs with disposable cups and there is a water fountain inside the classroom and outside in the play area ). All materials and surfaces are toxic free are inaccessible, no fireplace. Smoke detector and carbon monoxide is in working condition. Fire extinguisher(2A10BC) is in operable condition.

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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: SBCSS LUCERNE VALLEY STATE PRESCHOOL
FACILITY NUMBER: 364844174
VISIT DATE: 08/26/2024
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Restrooms: LPA inspected and observed (2 toilets and 3 sinks). LPA observed soap, toilet paper and paper towels readily available. Water temperature is appropriate. There is an isolation area for children who become ill while in care located near the teachers desk. Facility always maintains a comfortable temperature, first aid supplies (thermometer, bandages, scissors), sign in/out sheets (manually) available and completed daily. No Smoking prohibited on the premises, daily inspection for illness, no prohibited childcare items observed. Firearms/weapons are not allowed or stored on premises. There is no body of water on the premises.

Napping: The facility does not nap because this is a half day, 3-hour program.

Outdoor: The facility has one playground area for the preschool age children. Outdoor play equipment was inspected for health, safety, good repair, and age appropriateness. There are concrete areas for active play and also a padded area. The area was observed to be free of debris, free from hazard, holes, broken items, debris, cushioning material underneath. No bodies of water were observed, however there is water table that is drained after each class.. There are areas for shade and rest.

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



Health Related Services: Medications inaccessible to children; all prescription and non-prescription medications have child’s name and are dated; written consent and instruction from child’s representative, a plan to document and report to child’s representative when medication is administered to a child; IMS plan on file (if applicable).

Children are inspected for illnesses (wellness policy) as they arrive. A review of medication policy indicated that prescription medication is administered only with parent's written permission (licensing medication form- LIC9221 - also used). LPA advised the Director must administer medication, and document the dosage, date and time onto a log.
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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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: SBCSS LUCERNE VALLEY STATE PRESCHOOL
FACILITY NUMBER: 364844174
VISIT DATE: 08/26/2024
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 Medication can be brought and taken home by the parent daily. Medication will be properly labeled and stored in its original container.
This facility provides Incidental Medical Services – IMS. Currently no IMS.
LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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/childquanda.htm

Food Service: The preschool children obtain their meals from the elementary school cafeteria. Meals such as breakfast, lunch, and snacks are provided. Per lead teacher, the preschool children are only at the facility for three hours: AM session and PM session. LPA observed a food allergy list posted on the wall in the classroom .

Staff/Personnel Records: Director (qualified) qualifications were verified, Designation of Responsibility observed, immunization's, TB clearance, health screening, criminal record statement, statement acknowledging suspected child abuse and mandated reporter were observed in file.


Facility Records: Roster, fire/disaster drill log last completed on 08/22/2024. CPR/First Aid, and mandated report training were reviewed. A copy of the rooster was collected to put in file.

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, earthquake preparedness checklist.

Documents Provided and or Discussed: Forms and records to keep at the facility and IMS.
Advisory/Other: First Aid kit was observed with supplies (thermometer) readily available. CPR/First Aid expires on 05/22/2026. Mandated Reporter Training expires on 03/16/26.
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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: SBCSS LUCERNE VALLEY STATE PRESCHOOL
FACILITY NUMBER: 364844174
VISIT DATE: 08/26/2024
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Electrical outlets are inaccessible, recalled and or prohibited toys/play equipment were not 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 of the required forms posted. Fire/earthquake drills current. Roster current.

Director advised of the requirement to report Unusual Incidents. Lead Teacher 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 family day care home. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above.



Director 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.

Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. Director shall permit the Department to inspect the family childcare 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. To improve the quality and value of the new inspection process, a survey will be sent to the email address provided.

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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
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: SBCSS LUCERNE VALLEY STATE PRESCHOOL
FACILITY NUMBER: 364844174
VISIT DATE: 08/26/2024
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 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
No deficiencies were cited at this time.

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.
No deficiency. The On Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Exit interview conducted and report was reviewed with Director Phyllis Walker. This report was read and provided to the Director, along with her appeal rights and Notice of Site Visit.

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SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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