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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750169
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:13:32 PM

Document Has Been Signed on 09/04/2024 03:13 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:CCRC LPC HEAD STARTFACILITY NUMBER:
197750169
ADMINISTRATOR/
DIRECTOR:		BETTY ZAMORANO PEDREGONFACILITY TYPE:
850
ADDRESS:2320 EAST AVENUE RTELEPHONE:
(661) 273-0608
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 17DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:44 PM
MET WITH:Rosa Ayala Lopez, Director TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 09/04/24 at 12:44 PM, Licensing Program Analyst (LPA) Justeene Tamayo met with Director, Rosa Ayala Lopez, who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 08/19/24. LPA disclosed the purpose of the inspection. Upon arrival, there are 17 preschool children in care, along with 7 teachers.

Description of Incident: On 08/19/24, child #1 was running and fell onto cozy bed (bean bag) hitting their head on the window edge.

During the inspection, LPA interviewed staff, child #1, and other daycare children who witnessed the incident. It was revealed that staff had instructed the preschool children to walk instead of running inside the classroom. Despite this, child #1 became excited and jumped on the bean bag near the window, accidentally hitting their head on the window edge. Teachers #1 and #2 saw the incident but were unable to respond in time. First aid was administered, and the parents were immediately notified and given an "ouchie report." The bean bag has been removed, and a desk now barricades the lower corner window to prevent any other incidents from reoccurring.

This incident was deemed accidental, and no deficiencies were cited at this time.



An exit interview was conducted, a copy of this report was provided to Director, along with her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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