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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750105
Report Date: 03/04/2021
Date Signed: 03/04/2021 02:03:48 PM

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:GARDEN PATCH PLAY SCHOOL, THEFACILITY NUMBER:
197750105
ADMINISTRATOR:CHRISTIE COPLEYFACILITY TYPE:
850
ADDRESS:24436 VALLEY STTELEPHONE:
(661) 888-1198
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:45CENSUS: 16DATE:
03/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christie Copley, DirectorTIME COMPLETED:
02:30 PM
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On March 4, 2021 Licensing Program Analyst (LPA) Monique Ayala conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 03/02/2021; this incident was reported timely. LPA spoke with Director. Due to COVID-19 Emergency Response this inspection was conducted virtually. LPA virtually toured the facility and took a census of the children. Upon arrival, there were 16 children and 7 staff present today at the facility.

Description of the incident: On 02/26/2021 at approximately 11am C1 was playing on the slide when he lost his balance and hit his chin on the slide causing a cut on his chin. S1 observed the incident and provided first aid care. S1 applied pressure to C1's chin until bleeding stopped and a Band-Aid was applied. P1 was informed immediately by the director. P1 took C1 to Kaiser Urgent Care where 3 stitches were applied. (All names are located on confidential sheets LIC 811 and LIC 859)

During this inspection, LPA interviewed staff and obtained a copy of the facility roster. LPA received pictures from director where the incident took place.

No deficiencies were observed at the time of the visit.

An exit interview was conducted and a copy of this report was read and will be provided to the director via email on 03/04/2021.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021
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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