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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 143808560
Report Date: 02/23/2022
Date Signed: 02/24/2022 05:01:05 PM


Document Has Been Signed on 02/24/2022 05:01 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:ICSS - WEST BISHOP STATE PRESCHOOLFACILITY NUMBER:
143808560
ADMINISTRATOR:KAT DUNCANFACILITY TYPE:
850
ADDRESS:164 GRANDVIEW DRIVETELEPHONE:
(760) 873-5123
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY:24CENSUS: 14DATE:
02/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Katherina Johnson GE Preschool teacher TIME COMPLETED:
12:13 PM
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Licensing Program Analyst (LPA) Steven Montoya met with preschool staff (4) to inspection and follow up recent COVID UIR since January 2022.

At the time of Inspection, LPA observed 14 children in care with 4 teachers supervising children. All teacher wore masks while children were without masks. Teacher reports 50 percent are special needs without masks. Teacher presented LPA process for children without mask are special needs with IEP.

Teacher reports Daily COVID procedure check list: Children temperature taken at the door. Parents drop off children outside the classroom. Parents are provided masks.

Teacher provided a copy to the child care roster. LPA inspected classroom, restrooms and overall site cleanliness which meet state regulatory guidelines.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022
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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