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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911538
Report Date: 11/04/2024
Date Signed: 11/07/2024 12:14:25 PM

Document Has Been Signed on 11/07/2024 12:14 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PSD/HESPERIA HEAD STARTFACILITY NUMBER:
360911538
ADMINISTRATOR/
DIRECTOR:		HALL, PAULETTEFACILITY TYPE:
850
ADDRESS:9352 E AVENUETELEPHONE:
(760) 948-4411
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 105TOTAL ENROLLED CHILDREN: 105CENSUS: DATE:
11/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Paulette Hall, Site Supervisor TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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This report has been amended.
On November 4, 2024, Licensing Program Analyst (LPA) Crystal Ali met with Paulette Hall site supervisor, conduct an unannounced case management inspection. The purpose of the case management (CM) was to follow up on unusual incident report (UIR) received 10/25/24. Incident occurred on 10/16/24 at approximately 10:35am, child#1 was grabbed by the wrist by teacher and child #2 was tripped by the food service staff worker. No known injuries sustained.

Upon arrival, LPA observed 40 preschool and 15 staff member providing care.

During this inspection LPA received a copy of facility child roster (LIC 9040) and employee roster (LIC 500). LPA interviewed Paulette Hall regarding this incident. Intern, teacher, and food worker were not present at facility today. The facility’s internal investigation is pending. CM outcome is pending at this time.

No deficiencies have been cited at this time.

Exit interview conducted with Paulette Hall and Notice of Site Visit. Notice of site visit must remain posted for 30 days.
Claretta YatesTELEPHONE: (661) 202-3318
Crystal AliTELEPHONE: (661) 202-3409
DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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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