<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808551
Report Date: 01/31/2024
Date Signed: 01/31/2024 04:09:02 PM


Document Has Been Signed on 01/31/2024 04:09 PM - 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:FALLER STATE PRESCHOOLFACILITY NUMBER:
153808551
ADMINISTRATOR:MICHELLE A ARMSTRONGFACILITY TYPE:
850
ADDRESS:1500 WEST UPJOHNTELEPHONE:
(760) 499-1694
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:24CENSUS: 15DATE:
01/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Michelle Armstrong, Director TIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/31/24, Licensing Program Analysts (LPAs) Crystal Ali and Carol Heath met with Teacher Lizet Robles to conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received 1/29/24. Incident occurred on 1/26/24, child was running with friends and tripped over her feet and fell and hit her head on pole and sustained a knot on head and black eyes.

Upon arrival, LPAs observed 15 preschool and 3 staff member providing care.

During this inspection LPAs conducted interviews with 3 children, 3 staff, and parent #1. In addition, LPAs completed a safety inspection of the facility playground. In addition, during the inspection, LPAs obtained copies of facility roster and doctor medical report dated 1/30/24.

Due to the need to gather additional information, the case management will require further investigation.

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

Exit interview conducted with Director Michelle Armstrong.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Crystal AliTELEPHONE: (661) 202-3409
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1