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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911538
Report Date: 12/20/2022
Date Signed: 12/20/2022 10:30:03 AM


Document Has Been Signed on 12/20/2022 10:30 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:PSD/HESPERIA HEAD STARTFACILITY NUMBER:
360911538
ADMINISTRATOR:HALL, PAULETTEFACILITY TYPE:
850
ADDRESS:9352 E AVENUETELEPHONE:
(760) 948-4411
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:105CENSUS: 23DATE:
12/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Paulette HallTIME COMPLETED:
10:40 AM
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On 12/20/2022, Licensing Program Analyst (LPA) Carol Heath met Paulette Hall, Site Supervisor, for a Case Management Incident inspection involving an Incident Report dated 9/28/2022. The incident occurred on 9/27/2022. LPA spoke with the Site Supervisor Paulette. The total number of children at the preschool upon arrival is 23 children and 6 staff.

Description of the incident: Child #1 got bit by the other child.
On 09/27/22 at approximately 3:50 PM, Mrs. Holman (Teacher#1) and Mrs. Leidy (Teacher #2) were sitting in a circle on the carpet. Child #1 (LP) was sitting next to Teacher #1 on one side and Child #2 (RD) was sitting next to Teacher #1 on the other side. Child #2 said, "I am sorry" to Mrs. Holman and started to hug the teacher. Child #1 immediately started to hug Teacher #1 from the other side. Teacher #1 had the children sit on the spot. Child #1 stated that Child #2 bit him. Child #1 showed his right arm with a mark and no broken skin.
The parent received an Incident report. No medical attention was required from the doctor. Staff followed proper emergency procedures.

LPAs received child#1’s pictures. LPA received a copy of the Facility Roster. LPA interviewed Supervisor, teachers, and other related parties. Based on the information gathered and interviews, staff followed their reporting policy and procedure. Pre Director, the child was disenrolled on 10/18/2022.
No citation was issued on this date.

An exit interview was conducted and a copy of the report was read and provided to Paulette Hall, site supervisor.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2022
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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