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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911568
Report Date: 12/04/2019
Date Signed: 12/04/2019 12:58:26 PM

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:PSD-TWENTY NINE PALMS HEAD STARTFACILITY NUMBER:
360911568
ADMINISTRATOR:WILSON, DEBORAHFACILITY TYPE:
850
ADDRESS:71409 29 PALMS HIGHWAYTELEPHONE:
(760) 367-5150
CITY:TWENTYNINE PALMSSTATE: CAZIP CODE:
92277
CAPACITY:45CENSUS: 23DATE:
12/04/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Deborah WilsonTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Aaron Mabika met, Deborah Wilson, Site Supervisor for a Case Management Incident inspection involving an Incident Report dated 11/14/2019. The incident occurred on 12/25/2019.

Description of the incident: ON 09/24/2019 PRESCHOOL SERVICES DEPARTMENT (PSD) WILL START RENOVATION ON THE NORTH SIDE OF THE PLAYGROUND. CURRENTLY THE PLAY GROUND IS COVERED WITH WOOD CHIPS AND IT WILL BE REPLACED WITH RUBBER BASED FOUNDATION. THE PROJECT IS ESTIMATED TO BE COMPLETED ON OR BEFORE OCTOBER 2, 2019. PARENTS WERE VERBALLY NOTIFIED.

Facility followed the reporting protocol. LPA was taken on a tour of the playground to see the outcome of the renovations and observed a new cushion of foam rubber in place. Pictures were taken for the files

An exit interview was conducted and a copy of this report was read and provided to Deborah Wilson (Site supervisor), Acting Director on this date
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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