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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750004
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:14:28 AM


Document Has Been Signed on 09/22/2022 11:14 AM - 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:LEONA COX STATE PRESCHOOLFACILITY NUMBER:
197750004
ADMINISTRATOR:MILITZA GARCIAFACILITY TYPE:
850
ADDRESS:18643 OAKMOOR STREETTELEPHONE:
(661) 252-2100
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:24CENSUS: 10DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Escalante, JulieTIME COMPLETED:
11:40 AM
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On September 22, 2022, Licensing Program Analyst (LPAs) Barbara Beneroso and Andrew Alemoh conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 08/26/2022; this incident was reported timely. LPAs were greeted by Site Supervisor Julie Escalante who guided LPAs on a tour of the facility. Upon arrival, there were 10 children and 6 staff present today.

Description of incident: On 08/26/2022
The incident report indicated that Child #1 who is enrolled in the pre-school. Child # 1 was in the classroom sitting in the library area. Staff #1 observed Child 1 was not responding she checked Child 1 for a fever, however, Child 1 did not have a fever. Staff 1 left child 1 in the care of Staff 2 and Staff 3 and called Child 1's mom due to his unusual behavior. While with the other teachers were watching Child 1, his eyes rolled back and Child 1 slumped over on the child size couch in the library area. Child 1 was unresponsive and 911 was called immediately. Paramedics arrived within 5 minutes, Child 1's mom arrived one or two minutes after. Child 1 was transported to the hospital but he was not unconscious at the moment he was transported. No other injuries were found. Incident happened on at Friday Child 1 was back on the following Tuesday.

Staff handled the situation accordingly by providing first aid and immediately contacting child #1’s parents. During inspection, LPAs interviewed staff, site supervisor and children and obtained images of where the incident occurred and obtained a copy of the facility roster

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022
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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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: LEONA COX STATE PRESCHOOL
FACILITY NUMBER: 197750004
VISIT DATE: 09/22/2022
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 The information obtained during the unusual incident follow up revealed no violations were found.

Facility is encouraged to continue to report incidents that occur in the facility.

An exit interview was conducted, a copy of this report was provided along with the notice of site visit.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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