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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001280
Report Date: 09/01/2023
Date Signed: 09/01/2023 12:09:02 PM

Document Has Been Signed on 09/01/2023 12:09 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LANCASTER-NANCY CORY ELEMENTARY STATE PRESCHOOLFACILITY NUMBER:
192001280
ADMINISTRATOR:FOUNTAIN, KELLYFACILITY TYPE:
850
ADDRESS:3540 W. AVE K-4TELEPHONE:
(661) 718-2816
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 22DATE:
09/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Suzette Virata, Lead Teacher TIME COMPLETED:
12:15 PM
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On 09/01/2023, Licensing Program Analyst (LPA) Justeene Tamayo met with Lead Teacher Suzette Virata,who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident inspection regarding child #1 having a medical emergency in the facility. This Unusual Incident was self-reported within the time frame specified by regulations. Upon arrival LPA observed 22 day care children in care, along with 2 teachers and 1 teacher's aide.

Description of incident: On 08/15/23, child #1 suffered a suspected seizure, and was vomiting, but did not lose consciousness. EMS was provided, and child #1 was transported to the hospital via ambulance.

LPA Tamayo interviewed staff involved. During interviews with staff, it was disclosed child #1 is prone to seizures. 911 and the parents of child #1 were immediately called to the facility. Child #1 was turned on his side until EMS arrived.

At this time, the facility took appropriate measures to ensure the health and safety of child #1 and obtained emergency medical treatment in a timely manner.

No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was provided to the Lead Teacher, along with a Notice of Site Visit and her appeal rights.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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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