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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910433
Report Date: 03/17/2022
Date Signed: 03/17/2022 10:41:48 AM


Document Has Been Signed on 03/17/2022 10:41 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:PSUSD - DELLA S. LINDLEY HEAD STARTFACILITY NUMBER:
330910433
ADMINISTRATOR:TAIZA CEJAFACILITY TYPE:
850
ADDRESS:31-495 ROBERT ROADTELEPHONE:
(760) 343-7574
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY:45CENSUS: 36DATE:
03/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:ECE Coordinator Linda RodriguezTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 3/15/2022. The UIR documented an incident involving a child that became unresponsive while playing outside on the playground.

Upon arrival this date on 3/17/2022, LPA Lopez met with Paraprofessional Jennifer Martinez and Teacher Sheleilee Sullivan and stated the purpose of the visit. Records were reviewed and interviews were conducted with staff, children, including the subject child. It was determined that a child was observed unresponsive but, still breathing. Staff were able to provide the necessary first aid until paramedics arrived. By the time they arrived the child was already responsive.

LPA toured the playground, observed play structures, equipment, and rubber mat/material in place to absorb any fall. All items listed were in good repair at time of inspection. LPA also observed staff placement throughout the playground to maximize supervision of children in care while at play.

Based on the information gathered, observations made, it was determined that the facility complied with regulation requirements. No violations of Title 22 were identified.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the ECE Coordinator Linda Rodriguez.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2022
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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