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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010149
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:50:42 PM


Document Has Been Signed on 01/18/2024 02:50 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:SMART MONTESSORI SCHOOLFACILITY NUMBER:
198010149
ADMINISTRATOR:KANG, MEE RAHFACILITY TYPE:
850
ADDRESS:6401 FOOTHILL BLVD.TELEPHONE:
(818) 446-0909
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:79CENSUS: 59DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gabriella Martinez Cruz, Site SupervisorTIME COMPLETED:
03:00 PM
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On January 18, 2024 at 10:15 a.m., Licensing Program Manager (LPM) Mariela Ramon and Licensing Program Analyst (LPA) Evelyn Garcia conducted an unannounced case management visit to follow up on an Unusual Incident Report concerning an incident that occurred on January 11, 2024. It was reported to the Department on January 12, 2024. LPM and LPA met with Gabriella Martinez Cruz. LPA and LPM observed 59 preschoolers under the care and supervision of 10 teachers.

The incident report indicates that on 01/11/24 at approximately 10:30 a.m., Staff #1 noticed child #1 in discomfort in their left wrist and arm. Staff #1 brought child #1 to the office to be seen by an administrator. Child #1 was crying and pointing to their left wrist and arm, but no visible injuries were observed.The administrator contacted child #1's guardian at 11:06am to inform them child #1's discomfort and child #1 was picked up by their guardian at 2:15 p.m. On January 12, 2024, child #1 guardian, contacted the school (via text), that x-rays were taken and his arm was broken.

During the inspection today, LPA and LPM conducted interviews with staff members and two day care children, reviewed children's and staff files and viewed the facility's video recording of the incident. Further follow up is required at this time. An exit interview was conducted, a copy of this report, and notice of site visit were provided to Gabriella Martinez Cruz, Site Supervisor.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Evelyn GarciaTELEPHONE: (661) 202-3785
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2024
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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