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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290932
Report Date: 03/21/2023
Date Signed: 03/21/2023 11:32:58 AM

Document Has Been Signed on 03/21/2023 11:32 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: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: 76CENSUS: 26DATE:
03/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Michelle DupreyTIME COMPLETED:
11:35 AM
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On 03/21/2023 Licensing Program Analyst (LPA) Ortega arrived at the Facility to conduct a Case Management Inspection for an Unusual Incident Report (UIR) received at the Palmdale Regional Office. LPA met with Michelle Duprey, Director and toured the facility according to the facility sketch. At the time of arrival LPA observed 26 children in care and six staff providing care and supervision.

The purpose of this case management inspection is to follow up on a self reported unusual incident report (UIR) submitted to the Department on 3/20/2023. The unusual incident report was regarding an injury to Child #1 on the outdoor play structure.

During this inspection LPA conducted interviews with staff and completed a file reviews. LPA also completed a safety inspection of the facility's out door play area. In addition, during the inspection, LPA obtained copies of documentation related to the incident on 3/17/2023.

Facility followed protocol, three staff were providing care and supervision during the incident. According to interviews conducted Child #1 tripped over own feet and fell forward causing child to fall and get injured. Parent was notified in a timely manner and UIR was reported within the time frame required. Child #1 was has resumed normal activities.

No deficiencies will be cited today. A notice of site visit was provided and requested to be posted for 30 days. An exit interview was conducted, a copy of this report, notice of site visit and appeal rights were provided to facility.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2023
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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