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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401581
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:43:58 PM


Document Has Been Signed on 03/22/2023 02:43 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:ANTELOPE VALLEY COLLEGE CHILD DEV. CENTERFACILITY NUMBER:
197401581
ADMINISTRATOR:ORLIC-BABIC, KATARINAFACILITY TYPE:
850
ADDRESS:3041 WEST AVENUE KTELEPHONE:
(661) 722-6500
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: 26DATE:
03/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Katarina Orlic-Babic, Director TIME COMPLETED:
03:00 PM
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On 03/22/23, Licensing Program Analyst (LPA) Justeene Tamayo met with Director who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident inspection for two Unusual Incidents that occurred on 03/02/23 and 03/21/23. The Unusual Incidents were self reported within the time frame specified by regulations. Upon arrival, LPA observed 26 preschool children in care with 10 staff present, and the Director.

Description of incident #1: On 03/02/23, child #1 fell on the dirt while running outside with a friend. Child #1 tripped on child #2 foot. Child #1 got up and brushed self off. Staff #1 asked if child #1 was okay and child #1 responded they were okay. Staff #1 and staff #2 did not observe bruises, blood or scratches. On 03/03/23, child #1 arrived to school with a brace on the wrist and child #1 explained they fell at home.

Description of incident #2: On 03/21/23 at approximately 10:40 AM, child #1 placed hand on the table and another hand on the shelf. Child #1 lifted his body to swing his legs. Child #1 lost hold of the table and fell hitting his chin on the floor. Child #1 chin started bleeding and needed medical attention.

At this time further follow up is needed for the two Unusual Incident Reports that were received by the Department. No deficiencies are being cited at this time.

An exit interview was conducted and a copy of this report was provided to the Director, along with Notice of Site Visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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