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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910831
Report Date: 01/28/2025
Date Signed: 01/28/2025 11:52:51 AM

Document Has Been Signed on 01/28/2025 11:52 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PSD/APPLE VALLEY HEAD STARTFACILITY NUMBER:
360910831
ADMINISTRATOR/
DIRECTOR:		MAGDALENA LOZANOFACILITY TYPE:
850
ADDRESS:13589 NAVAJO ROADTELEPHONE:
(760) 247-6955
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 117TOTAL ENROLLED CHILDREN: 117CENSUS: 49DATE:
01/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:MAGDALENA LOZANOTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On January 28,2025 Licensing Program Analyst (LPA's) Sherell Braddock and Hannah Cha conducted a subsequent Case Management inspection to deliver the findings for a self-reported unusual incident that, occurred on December 09th , 2024. LPA met with MAGDALENA LOZANO to discuss the investigation. The investigation consisted of interviews with relevant parties, including staff, parents and children.

Children interviewed were not intimidated or scared of the teacher who grabbed C3, however based on the information obtained from creditable interviews, the investigation has revealed that staff 3 handled child 3 roughly, holding his hands together.

Based on the information gathered the facility will be issued a Type B deficiency for personal rights violation for the incident where Staff 3 violated Child 3 personal Rights when she tried to restrain C3 by grabbing him by his arms and legs and holding them together. The child did not receive any injury or bruises from the incident.

Upon receipt of the Type B Violation, this report shall be posted for 30 days in addition to the Notice of Site Visit.

An exit interview was conducted with program Manager Magdalena Lozano, and a copy of this report, the notice of site visit, and the appeal rights provided on this day.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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Document Has Been Signed on 01/28/2025 11:52 AM - It Cannot Be Edited


Created By: Sherell Braddock On 01/28/2025 at 11:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PSD/APPLE VALLEY HEAD START
FACILITY NUMBER: 360910831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/18/2025
Section Cited
CCR
101223(a)(3)

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The licensee shall ensure that each child is accorded the following personal rights:
To be free from corporal or unusual punishment...interference with functions of daily living including eating, sleeping.....This requirement was not met as evidenced by:
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Director will provide a training to the staff in question and have staff answer prompt questions to enusre that she undertstands personal rights and childrens safety
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Based on interviews with Staff, Child 3 personal right was violated, which poses an Potential Health and Safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Sherell Braddock
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2025


LIC809 (FAS) - (06/04)
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