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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810039
Report Date: 06/01/2023
Date Signed: 06/01/2023 09:27:23 AM

Document Has Been Signed on 06/01/2023 09:27 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SBCUSD-HUNT PRESCHOOLFACILITY NUMBER:
364810039
ADMINISTRATOR:LATASHIA KELLYFACILITY TYPE:
850
ADDRESS:1342 PUMALO STREETTELEPHONE:
(909) 881-8178
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 13DATE:
06/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Facility Representative Delmy SchwartzmanTIME COMPLETED:
09:35 AM
NARRATIVE
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On June 1, 2023, at 08:45 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Case Management Other 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. 13 children and (2) two staff members were present in the facility during the inspection.

The purpose of the inspection was to conduct a follow-up case management inspection regarding a self-reported unusual incident report (UIR) that occurred on April 21, 2023, at the facility. Over the course of investigating the above UIR, the Department reviewed staff files, child files, and reviewed the Centers program statement. During the inspection on April 26, 2023, LPA conducted interviews with staff (S1 and S2) who were present at the time of the incident. Per interviews, S1 was inside the classroom with three or four children while S2 was on the playground with six children. S2 reported their role was an “Instructional Aide”. S1 reported their role was a “teacher”. LPA reviewed the job description for an Instructional Aide. Per job description “this classification exercises no supervision”. LPA reviewed S2’s staff file. Per LPA’s file review, S2 meets the qualification of a Teacher Aide and therefore shall work only under the direct supervision of a teacher. A deficiency is being cited based on interviews and record review in accordance with the California Code of Regulations, Title 22, see LIC 809D.

Notice of site visit was given and must remain posted for 30 days. An exit interview was conducted and the report was reviewed with the facility representative Delmy Schwartzman.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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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Document Has Been Signed on 06/01/2023 09:27 AM - It Cannot Be Edited


Created By: Kendal Zirbes On 06/01/2023 at 09:06 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: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/01/2023
Section Cited
CCR
101216.2(e)

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101216.2 Teacher Aide Qualifications and Duties (e) An aide shall work only under the direct supervision of a teacher. This requirement was not met as evidenced by:
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Per facility representative, the staff were provided with supervision training on 5/15/2023. A copy of the training was submitted to the Department on 5/15/2023. No further action is required.
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Based on interviews and record review, S2 was alone on the playground with six children on April 21, 2023, therefore S1 was not have provided direct supervision of S2. This poses a potential Health and Safety risk to persons 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:Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023


LIC809 (FAS) - (06/04)
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