Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808719
Report Date: 12/07/2018
Date Signed 12/07/2018 02:19:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:AVUSD MARIANA STATE PRESCHOOLFACILITY NUMBER:
364808719
ADMINISTRATOR:BILL CLAYFACILITY TYPE:
850
ADDRESS:10601 MANHASSET ROADTELEPHONE:
(760) 247-7258
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:48CENSUS: 18DATE:
12/07/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marlene Vaselenko-SquiresTIME COMPLETED:
02:30 PM
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ON 12/7/18 at 12:00 PM Licensing Program Analysts (LPA Yates met with Lead Teacher Marlene Vaselenko-Squires, today for the purpose of conducting an unannounced Required 3-year inspection for the Pre-School. There are 18 children present upon arrival with 3 teacher and 1 classrooms. Per Lead Teacher the hours of operation are 8:15 Am - 11:15 AM and 12:15 PM -3:15 PM Monday -Friday. This facility provides Incidental Medical Services (IMS). However all records and medications are stored in the Elementary School Nurse's Office.

LPA verified there is at least 1 staff person present with current CPR and First Aid training (exp. 04/20/20).
*Snack menus, Allergy list were reviewed and posted. Food and snacks were reviewed for availability, quantity, proper storage, and appropriateness to children in care. Only snacks are provided to children. There is a small refrigerator located in the Pre-School Classroom for milks and juices.
*Disinfectants, cleaning solutions, poisons and other items that are dangerous or hazardous were inaccessible to children in lock cabinets.
The classroom has a water fountain; however the water fountain is loose and need repaired.
* A waiver is on file for the Pre-School to share the bedroom with the Kindergarten children. LPA observed soap, paper towel and toilet paper and water tested at a safe temperature.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: AVUSD MARIANA STATE PRESCHOOL
FACILITY NUMBER: 364808719
VISIT DATE: 12/07/2018
NARRATIVE
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A review of medication policy indicated that prescription medication is administered only with parent's written permission. Per Lead Teacher the school nurse administers medication and documents the dosage, date and time onto a log. Medication brought and taken home by the parent daily. Medication is properly labeled and stored in its original container.
*Center was found to be operating within its specified ratio and capacity.
*Sign in and Out sheets were inspected.
A sampling of children’s files was reviewed and contained emergency contact information, staff files were reviewed and contained qualifications.

LPA discussed the following:
Senate Bill AB 633 - Child Care Facilities: Parent Notification Requirements
Summary: This bill amends Health and Safety Code (HSC) sections 1596.859, 1596.8595, 1596.8895, and 1597.05 to improve the transparency of licensing records and to ensure that parents/guardians using a licensed child care facility (Center or family child care home) are aware of situations that present the greatest danger to children. These situations include:
· Serious health and safety violations resulting in Type A citations;
· Non-compliance conferences; or
· Efforts by the Department to revoke a facility’s license. Each report (documenting a Type A citation) shall remain posted for 30 days along with the Notice of Site Visit (printed out during this inspection). Failure to meet the posting requirements shall result in an immediate civil penalty. In addition, all parents of currently enrolled children and any newly enrolled child for the following 12 months shall receive a copy of report and sign the LIC 9224 acknowledging receipt. Civil Penalty assessments will be assessed if all above requirements are not adhered to.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: AVUSD MARIANA STATE PRESCHOOL
FACILITY NUMBER: 364808719
VISIT DATE: 12/07/2018
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*All flooring was found to be clean and safe Per the Lead Teacher the carpets are cleaned 2-3 times a year.

**Teacher/child ratio observed, care and supervision was discussed, children's records were reviewed, parent board observed and fire drills are current. Fire extinguisher meets the Fire Marshal Standards.
*Trash cans/storage containers for solid waste have tight-fitting covers and in good repair.
*Outdoor area and equipment was inspected for safety, cushioning material, good repair and age appropriateness. LPA noted shade, and 2 water fountains. There are no bodies of water on the premises.
*Isolation area is located in the classroom away from the other children in care.

ADMINISTRATION:
*Verification of Staff Requirements for State Pre-School is reviewed and fingerprints for all employees and criminal record clearance is obtained as a requirement of employment. This included all permit teachers, (or any other staff that is required to be fingerprint cleared and has had health screening & TB test). These documents are kept on file in the Human Resources Office.

LPA reviewed the Child are Facility Roster and Sign-In sheets.
Director is aware that the Department has full inspection authority as specified in Health and Safety Code 1596.852, 1596.853, and 1596.535.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AVUSD MARIANA STATE PRESCHOOL
FACILITY NUMBER: 364808719
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/21/2018
Section Cited
CCR
101239(n)
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101239(n) Fixtures, Furniture, Equipment and Supplies. Furniture and equipment shall be in good condition, free of sharp, loose, or pointed parts. On 12/7/18 LPA observed the water fountain located in the pre-school classroom to be loose which may pose a heath and safety risk to children in care.
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Per Lead Teacher a work order will be made to repair the classroom water fountain by the due date 12/21/18.
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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: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2018
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, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME: AVUSD MARIANA STATE PRESCHOOL
FACILITY NUMBER: 364808719
VISIT DATE: 12/07/2018
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This facility provides Incidental Medical Services – IMS. Per Lead Teacher all medication and records are stored in the nurse's office. 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 Centers and ADA, available at: http://www.ada.gov/childqanda.htm

Licensee is advised to visit www.shotsforschool.org for Immunization information.
Licensee was informed of responsibility to report suspected Child Abuse, 1-800-540-4000.
Licensee is advised for quarterly updates to contact the Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Facility was cited Type B deficiency(ies), according to California Code of Regulations Title 22 See LIC 809D report for deficiencies.

Exit interview conducted with Lead Teacher Marlene Vaserlenko-Squires. A copy of the Appeal Rights (LIC 9058) were given and explained. Lead Teacher signature on this form acknowledges receipt of these rights.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in visible location the authorized representatives of children.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2018
LIC809 (FAS) - (06/04)
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