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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290932
Report Date: 09/15/2021
Date Signed: 09/15/2021 03:02:49 PM

Document Has Been Signed on 09/15/2021 03:02 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:RISE AND SHINE PRE-SCHOOLFACILITY NUMBER:
191290932
ADMINISTRATOR:DUPREY, MICHELLEFACILITY TYPE:
850
ADDRESS:25222 WILEY CANYON ROADTELEPHONE:
(661) 259-0407
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY: 76TOTAL ENROLLED CHILDREN: 0CENSUS: 30DATE:
09/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Director Michelle DupreyTIME COMPLETED:
03:15 PM
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On September 15, 2021 at 11:18AM, Licensing Program Analyst (LPA) Brigitte Tsutaoka conducted an unannounced Case Management - Incident inspection. LPA disclosed the purpose of inspection and was greeted by Assistant Director who took LPA's temperature and permitted entry into the facility. At 11:40AM, Director Michelle Duprey met with LPA and guided LPA on a tour of the facility. LPA counted 30 children in care with 7 staff, confirmed on association list. LPA observed children during nap and while eating their lunch.

During inspection, LPA conducted staff and child interviews. Child 1 was running on the playground while playing a game of "Chase" with 3 other children. Child 1 ran to the outdoor play structure steps, tripped over the first step and hit his head on the second step, resulting in a laceration right below his right eyebrow. Staff 2, who was located in the corner adjacent to the sandbox next to planters observed Child 1 running to the play structure and trip on the first step. Staff 2 did not observe Child 1 make contact with the step, but she did observe him fall down. Staff 2 immediately began walking toward Child 1 as Child 1 got up and began walking toward Staff 2. Child 1 was holding his head as he walked over and once he removed his hand, Staff 2 and Child 1 observed the blood and injury.

Staff 2 request Child 1 hold his hand over his injury while they walk to the office. Staff 2 and Child 1 were intercepted by Staff 3 and Staff 4 who were cleaning the Gym Classroom. Staff 2, Staff 3, Staff 4, and Child 1 walked to the office together. Staff 3 and Staff 4 cleaned the laceration and spoke with Child 1 to calm him down. Staff 2 returned to the playground to check for/clean up any spilled blood and continue to provide supervision to the children outside. During that time, Staff 2 stated there were an additional 3 staff outside to provide supervision to the children playing on the playground.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: RISE AND SHINE PRE-SCHOOL
FACILITY NUMBER: 191290932
VISIT DATE: 09/15/2021
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Staff 4 contacted Child 1's parents, who picked up Child 1 and took Child 1 to the hospital where he obtained stiches for the injury. Staff 3 and Staff 4 stayed with Child 1 until his parent came to the facility to pick him up.

LPA observed the play structure and steps where incident occurred and did not observe any damage/disrepair to the structure which could have contributed to the fall. The structure is in good condition with no observable hazards.

Director disclosed the Outdoor Safety Rules were reviewed with all staff during the annual In-Service Training conducted the 3 days preceding the new school year and an updated copy of the playground rules were distributed to each staff.

Based on evidence obtained and interviews conducted, no deficiencies were noted and no citations will be issued today. An exit Interview was conducted, a copy of this Report, Appeal rights and a Notice of Site visit were provided to the Director.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Brigitte Tsutaoka
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
LIC809 (FAS) - (06/04)
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