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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419664
Report Date: 07/18/2023
Date Signed: 07/18/2023 02:02:34 PM


Document Has Been Signed on 07/18/2023 02:02 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:KIDS' CORNER PRESCHOOLFACILITY NUMBER:
197419664
ADMINISTRATOR:RFACILITY TYPE:
850
ADDRESS:4020 LANCASTER BLVD.TELEPHONE:
(661) 946-4668
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:79CENSUS: 6DATE:
07/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Eric LeeTIME COMPLETED:
01:40 PM
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On 07/18/2023 at 9:20 A.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at Kids Corner Preschool. LPA met with Administrator Eric Lee. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 06/07/2023 at the center. LPA observed 6 children and 2 staff. LPA obtained a copy of the Sign In/Sign Out sheet and a copy of the video recording from the administrator dated 06/07/2023.

Description of the incident: One of the teachers have the children sit in a circle to play a game. Teacher #1 went into the circle to put some toys out but child #1 moved over and ended up directly behind teacher #1. When teacher #1 stepped back, she ended up falling on top of child #1. Child #1 was upset and hurt her arm. Teacher #1 calm child #1 down and assess any injuries that child #1 might have.

During the inspection, LPA interviewed the administrator, 2 staff, and 3 children.

Based on the information gathered and, on the recorded video provided, two teachers (Teacher #1 and #2) were supervising 10 children before doing the circle time when the incident happened. Teacher #2 was behind the white board and was putting additional 3 footsteps on the floor for children to step into. On the other hand, teacher #1 got the cubes (toys) from the cubbies and try to put them at the center where children can observe how teacher #1 is doing it. Children were seated on the stars that were posted on the floor. While teacher #1 was putting the cubes at the center, child #1 scooted over to the left and went behind teacher #1. Teacher #1 stepped backward and accidentally fell on child #1. There is not a preponderance of the evidence to prove that Child #1 was intentionally injured
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2023
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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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: KIDS' CORNER PRESCHOOL
FACILITY NUMBER: 197419664
VISIT DATE: 07/18/2023
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Pg 2

while child was at the school; the incident that happened was an accident, Teacher to child ratio was also met; therefore, the above allegation is Unsubstantiated.

LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.

Exit interview was conducted, Appeal Rights and a copy of this report were provided to Administrator Eric Lee.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC809 (FAS) - (06/04)
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