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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409311
Report Date: 03/01/2023
Date Signed: 03/01/2023 01:08:10 PM


Document Has Been Signed on 03/01/2023 01:08 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:LANCASTER-WEST WIND ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
197409311
ADMINISTRATOR:FOUNTAIN, KELLYFACILITY TYPE:
850
ADDRESS:44044 NORTH 36TH STREET WESTTELEPHONE:
(661) 940-8992
CITY:LANCASTER,STATE: CAZIP CODE:
93536
CAPACITY:48CENSUS: 21DATE:
03/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Enedina Lepe, Lead TeacherTIME COMPLETED:
01:20 PM
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On 02/28/23, Licensing Program Analyst (LPA), Justeene Tamayo conducted a case management incident visit. LPA met with lead teacher Enedina Lepe for the purpose of addressing an unusual incident that occurred at the facility on 02/21/23 and was reported to the Department on 02/21/23. Upon arrival, LPA observed 21 preschool children, along with 4 teachers.

The incident reported indicated on 02/28/23 at approximately 10:50AM, child #1 was unresponsive and needed medical attention. Child #1 was transported to the hospital by EMS.

Based on interviews conducted, it was revealed staff #2 called 911 immediately while staff #1 assisted with child #1 until EMS arrived.

No deficiencies will be cited at this time.

Exit Interview conducted and a copy of this report was provided to Lead Teacher Enedina Lepe , along with notice of site visit and appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2023
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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