364810039-4-26-2023-12-CC-KZIS-CR9RU5-20230426131921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364810039
Report Date: 04/26/2023
Date Signed: 04/26/2023 01:19:37 PM

Document Has Been Signed on 04/26/2023 01:19 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	SBCUSD-HUNT PRESCHOOL		FACILITY NUMBER:	364810039
ADMINISTRATOR:	LATASHIA KELLY		FACILITY TYPE:	850
ADDRESS:	1342 PUMALO STREET		TELEPHONE:	(909) 881-8178
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 23	CENSUS: 9	DATE:	04/26/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Facility Representative Delmy Schwartzman		TIME COMPLETED:	01:30 PM

NARRATIVE

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On April 26, 2023, at 10:25 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Case Management Incident inspection and met with facility representative, Delmy Schwartzman. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. Nine (9) children and (2) two staff were present in the facility during the inspection.

The purpose of the inspection was to follow up on a self-reported unusual incident report (UIR) which occurred on April 21, 2023 at the facility. The Department was notified of the UIR on April 24, 2023. According to the UIR, Child 1 (C1) (three years old) wandered off campus around 2:45-2:50pm. Per UIR, C1 was found off campus and a police officer brought C1 back to the front office.

During the inspection today, LPA interviewed staff and reviewed video evidence of the incident. Per information received from interviews, at the time of the incident staff 1 (S1) and staff 2 (S2) were providing supervision. S1 was in the classroom with three or four children. S2 was on the playground with six children. C1 finished a project inside the classroom and asked to go to the playground. According to S1, S1 opened the classroom door, and watched C1 walk down the ramp headed towards the playground. S1 turned his/her attention to another child inside the classroom who was calling S1s name and did not observe C1 leaving the path to the playground. Once all students finished their project inside the classroom, S1 brought the remaining students out to the playground. Once on the playground, S1 conducted a student count and realized C1 was missing. According to the information received C1 was located by a police officer on a Conejo Dr. approximately 100 yards away from Hunt Elementary.

Per video evidence, C1 exited the classroom at 2:30 p.m. Interviews reported C1 was located off campus with a police office at approximately 3:05 p.m.

Report continued on page two

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: SBCUSD-HUNT PRESCHOOL	FACILITY NUMBER: 364810039
	VISIT DATE: 04/26/2023

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Report continued from page two

LPA completed a safety inspection of the classroom and playgound at 12:45 p.m. Zero physical plant deficiencies were observed. LPA observed the enclosed playground is located approximately 37 feet away from the classroom door.

Based on interviews conducted with staff and record review, the facility failed to provide the care and supervision necessary to meet C1 needs when C1 wandered away from the facility on April 21, 2023 and was without staff supervision for approximately 35 minutes. Therefore, California Code of Regulations, Title 22, Division 12, Chapter 1, regulation 101229(a)(1) Responsibility for Providing Care and Supervision, is being cited on the attached LIC 809D.

The licensee is being cited a Type A citation for Responsibility for Providing Care and Supervision. Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit and provide copies of the licensing report to parents/guardians of children in care at the facility.

This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months and the licensee will obtain a signed acknowledgment of Licensing Reports (LIC9224) from the parent/guardian and place it in each child's file. If these requirements are not met, civil penalties will be assessed.

An exit Interview was conducted, and a copy of the report and Notice of the Site Visit were read and provided to the Facility representative, Delmy Schwartzman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/26/2023 01:19 PM - It Cannot Be Edited

Created By: Kendal Zirbes On 04/26/2023 at 11:30 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: SBCUSD-HUNT PRESCHOOL	FACILITY NUMBER: 364810039
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/27/2023 Section Cited CCR 101229(a)(1)	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision ... necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Per facility representative, a written analysis of where the breakdown in current procedures occurred, how we can correct the situation to ensure that this does not happen again, and what measures of monitoring will be implemented to ensure staff is following the procedures, will be submitted to the Department within 24 hours.
	8 9 10 11 12 13 14	Based on record review and interviews, C1 wandered away from the classroom and was without the supervision of a teacher for approximately 35 minutes. This posed an immediate risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Kendal Zirbes

LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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