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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407723
Report Date: 03/27/2024
Date Signed: 03/27/2024 01:09:38 PM

Document Has Been Signed on 03/27/2024 01:09 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:PALMDALE SCHOOL DISTRICT - PALM TREE HEAD STARTFACILITY NUMBER:
197407723
ADMINISTRATOR:DR. MELANIE CULVERFACILITY TYPE:
850
ADDRESS:326 EAST AVENUE RTELEPHONE:
(661) 265-1744
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 37DATE:
03/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Lisa Fowler Assistant Administrator and Joe Vega, School Coordinator TIME COMPLETED:
12:00 PM
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On 03/27/2024, Licensing Program Analysts (LPAs) Justeene Tamayo and Sherell Braddock met with Lisa Fowler (Assistant Administrator) and Joe Vega (School Coordinator) who guided LPAs on a tour of the facility. The purpose of this visit was to conduct a follow up Case Management - Incident inspection for an Unusual Incident that was received by the Department on 03/14/2024. The Unusual Incident was self-reported within the time frame specified by regulations. Upon arrival, LPAs observed a total of 37 preschool children in care, along with 4 lead teachers, and 4 assistant teachers providing care and supervision.

Description of incident: On 03/13/24, child #1 was climbing down the stairs on outdoor equipment and tripped over their feet, resulting hitting their chin on the stairs.

After interviews conducted with staff and children, it was revealed the facility took appropriate measures to ensure the health and safety of each child. There was no immediate danger to child #1, and the fall was accidental.

No deficiencies are being cited at this time.

An exit interview was conducted, and a copy of this report was provided to the School Coordinator, along with his appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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