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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843210
Report Date: 02/08/2023
Date Signed: 02/23/2023 11:43:45 AM


Document Has Been Signed on 02/23/2023 11:43 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:HOOPER FAMILY CHILD CAREFACILITY NUMBER:
364843210
ADMINISTRATOR:HOOPER, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 886-2394
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:14CENSUS: 6DATE:
02/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Licensee, Kimberly HooperTIME COMPLETED:
11:45 AM
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 LPA Maddox met with Kimberly Hooper, Licensee today for the purpose of conducting a Case Management Inspection regarding a self reported incident that occurred on 12/8/2022. Upon arrival LPA observed 6 children, licensee and her husband.

On 12/8/2022 at 1/19/2023, at approximately 12:30 pm. Licensee states on the date of the incident, there were 4 children present. She states due to recent viral infection (RSV) going around, she took the temperature of all the children that morning and child #1's temperature was normal. The incident occurred at nap time, Licensee states child #1 had just gone to sleep and after approximately 10 minutes, she noticed child #'s body began jerking, his eyes were rolling up, and he was foaming at the mouth. Licensee states she immediately called 911 first who instructed her to turn child on his side and let him go through the process. After calling 911, Licensee telephoned Mom who arrived while the Paramedics were present. The paramedics arrived within 5 and 10 minutes and took his vitals which were normal, child was taken to the nearest hospital.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: HOOPER FAMILY CHILD CARE
FACILITY NUMBER: 364843210
VISIT DATE: 02/08/2023
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LPA reviewed child's file and there is no mention of any prior illness and history of seizures. Licensee's CPR and First Aid training cards were current (exp 6/2024).

Based on information provided, LPA has concluded Licensee took the necessary actions by calling 911 immediately. No deficiencies will be sited at this time. A copy of this report was provided to Director and Owner.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023
LIC809 (FAS) - (06/04)
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