<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202102
Report Date: 04/22/2024
Date Signed: 04/22/2024 03:22:19 PM


Document Has Been Signed on 04/22/2024 03:22 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:ST. STEPHEN'S PRESCHOOLFACILITY NUMBER:
191202102
ADMINISTRATOR:FOSTER, AMANDAFACILITY TYPE:
850
ADDRESS:24901 ORCHARD VILLAGE RDTELEPHONE:
(661) 259-8527
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:80CENSUS: 10DATE:
04/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director Vivien Firta TIME COMPLETED:
03:45 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 April 22, 2024, at , Licensing Program Analyst (LPA) Andrew Alemoh conducted an unannounced Case Management Incident inspection and met with facility representative, Vivien Firta. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. Ten (10) children and (2) two staff were present in the facility during the inspection.

The purpose of the inspection was to follow up on a self-reported unusual incident report (UIR) which occurred on April 19, 2024 at the facility. The Department was notified of the UIR on April 19, 2023. According to the UIR, Child 1 (C1) (three years old) wandered off campus around 12:57pm. Per UIR, C1 was found at the front entrance gate were a parent was seen to observe the child and bring the child to the front office.

During the inspection today, LPA interviewed staff and reviewed video evidence of the incident. Per information received from interviews, at the time of the incident staff 1-5 (S1-S5) were providing supervision to the children in the outside play yard area. Nanny brought C1 back to the facility at 12:39PM and was checked in at the play yard area. C1 was observed eating a granola bar in the play yard lunch table. C1 nanny had left the facility after providing C1 a granola bar. C1 went into the (red room) classroom were the other classroom door was propped open at 12:55PM. C1 walked out of the (red room) to the front entrance gate were he was able to open it. Shortly after opening and exiting through the front entrance a parent was coming to pick up a child when she had seen C1 by the front entrance were the parent asked C1 if someone is with C1. By 12:57PM C1 said no and the parent brought the child back into the facility at the front office.

Per video evidence, C1 exited the classroom at 12:57 p.m. Interviews reported C1 was located right outside the front gate entrance at approximately 12:57PM.

Report continued from page two

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 04/22/2024 03:22 PM - It Cannot Be Edited

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: ST. STEPHEN'S PRESCHOOL
FACILITY NUMBER: 191202102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2024
Section Cited
HSC
101229(a)(1)

1
2
3
4
5
6
7
101229(a)(1) Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision ... necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Per facility representative, a written analysis of where the breakdown in current procedures occurred, how we can correct the situation to ensure that this does not happen again, and what measures of monitoring will be implemented to ensure staff is following the procedures, will be submitted to the Department within 24 hours.
8
9
10
11
12
13
14
Based on record review and interviews, C1 wandered away from the classroom and was without the supervision of a teacher for approximately 2 minutes. This posed an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: ST. STEPHEN'S PRESCHOOL
FACILITY NUMBER: 191202102
VISIT DATE: 04/22/2024
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
LPA completed a safety inspection of the (red room) classroom and play gound at 3:00PM. Zero physical plant deficiencies were observed. LPA observed the classroom door and the front entrance door to be around 20 feet apart.

Based on interviews conducted with staff and record review, the facility failed to provide the care and supervision necessary to meet C1 needs when C1 attempted to wander away from the facility on April 19, 2024 and was without staff supervision for approximately 2 minutes. Therefore, California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101229(a)(1) Responsibility for Providing Care and Supervision, is being cited on the attached LIC 809D.

The licensee is being cited a Type B citation for Responsibility for Providing Care and Supervision. Upon receipt of a Type B deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit.

An exit Interview was conducted, and a copy of the report and Notice of the Site Visit were read and provided to the Facility representative, Vivien Firta

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3