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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750043
Report Date: 04/23/2019
Date Signed: 04/23/2019 11:16:28 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:LITTLE DREAMERS PRESCHOOLFACILITY NUMBER:
197750043
ADMINISTRATOR:LEE, EUNAEFACILITY TYPE:
850
ADDRESS:16200 CHATSWORTH STTELEPHONE:
(213) 255-8948
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:90CENSUS: 18DATE:
04/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Kaylee LeeTIME COMPLETED:
11:31 AM
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 Licensing Program Analyst's (LPAs) Ortega and Thompson-Miller met with Owner Kaylee Lee, for a Case Management Incident inspection involving an Incident Report dated April 18, 2019. The incident occurred on April 18, 2019.


Description of the incident: Child #1 during nap time, child slipped and hurt her chin on the edge of the plastic cot.

Interviews were conducted with children, parent and staff. Child #1 was not present on this day. It was determined Child #1 was crawling forward on the cot and when crawling backwards she lost her balance and slipped, injuring her chin on the edge of the cot. Staff #1 witnessed the incident. Parents were notified in a timely matter and Child #1 was taken to the hospital by parents and received stiches.

Based on information provided and interviews conducted the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore no deficiencies were cited.

During inspection unusual incident/injury report was provided.

An exit interview was conducted and a copy of this report was read and provided to the Owner, Katylee Lee on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2019
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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