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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840739
Report Date: 04/17/2024
Date Signed: 04/17/2024 11:19:24 AM


Document Has Been Signed on 04/17/2024 11:19 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:PSD/NORTHGATE HEAD STAR/STATE PRESCHOOLFACILITY NUMBER:
364840739
ADMINISTRATOR:IRMA SANTOSFACILITY TYPE:
850
ADDRESS:17251 DANTE STREETTELEPHONE:
(760) 951-1425
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:32CENSUS: 14DATE:
04/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Irma SantosTIME COMPLETED:
11:30 AM
NARRATIVE
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On April 17th, 2024, Licensing Program Analyst (LPA) Braddock and Licensing Program Manager (LPM) King conducted a follow-up inspection at the PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL for a self-reported unusual incident report received on April 2nd stating Staff 1 (S1) grabbed Child 1 (C1) by the arm. The purpose of the visit was to deliver findings regarding the above allegation. LPA met with Irma Santos who granted access. LPA observed 14 children and 3 staff in care.

During the investigation, LPA conducted confidential interviews. Interviews revealed before S1 grabbed C1's arms, S1 and C1’s parent exchanged words that were not happy greetings. S1 states” The child's hands were grabbed to walk the child over to the sink to wash the child’s hands. None of the information that was gathered revealed that C1 was a danger to themselves or others, justifying the need for S1 to grab C1 by the arm. From the information gathered S1 did not utilize verbal techniques to have C1 wash hands.

Based on the confidential interviews with staff, children, parents, and all parties involved, the evidence corroborates the allegation that S1 grabbed C1 by the arm in front and other children therefore, a Type B deficiency was cited during this inspection. Per Title 22 Regulations, Division 12, Chapter 1, for Personal Rights 101223 (a)(1). See 9099 D page.

An exit interview was conducted, and a copy of this report was read, Appeal Rights were discussed, and a Notice of Site Visit, and a copy of all forms mentioned were provided to the Licensee, / Facility Representative, at the facility. A Notice of Site Visit must remain posted for 30 days. Removal of the posting is subject to a $100 civil penalty.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR NAME: Sherell BraddockTELEPHONE: (661) 202-3412
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
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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Document Has Been Signed on 04/17/2024 11:19 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: PSD/NORTHGATE HEAD STAR/STATE PRESCHOOL
FACILITY NUMBER: 364840739

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2024
Section Cited
CCR
101223(a)(1)

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The licensee shall ensure that each child is accorded the following personal rights:

(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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Director states would conduct training based on personal rights and how to redirect children verbally. Director will send a sign in sheet by POC DATE.
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This requirement was not met as evidenced by :. S1 grabbed C1 to direct C1 to sink to wash hands. This poses a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR NAME: Sherell BraddockTELEPHONE: (661) 202-3412
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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