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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820543
Report Date: 04/24/2024
Date Signed: 04/24/2024 01:20:49 PM

Document Has Been Signed on 04/24/2024 01:20 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:AVUSD SITTING BULL ELEMENTARY SCHOOLFACILITY NUMBER:
364820543
ADMINISTRATOR/
DIRECTOR:		MARLENE EMLAYFACILITY TYPE:
850
ADDRESS:19445 SITTING BULL ROADTELEPHONE:
(760) 240-5278
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
04/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Carrie Mendez, Lead Teacher TIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On April 24, 2024, at 12:00 p.m., Licensing Program Analysts (LPAs) Braddock and Tamayo met with Licensee/facility representative, Carrie Mendez 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 04/18/24. LPAs disclosed the purpose of the inspection to the facility representative. When LPAs arrived at the facility there were 20 preschool children in care with 2 lead teachers, and 2 assistant teachers. The hours of operation for the program are 8:30 am to 11:30 am and 12:30pm to 3:30pm.

Description of Incident: On 04/18/24 at 2:45PM, child #1 and child #2 were playing outside on the playground. Child #1 pinned child #2 down on the ground and bit child #2 in the back. Ice was applied to child #2 back after the incident occurred.

During the inspection LPAs interviewed staff, child #1, and other relevant parties. From interviews conducted, it was revealed child #1 bit child #2 due to child #1 wanted to play with a bouncy ball outside. The occurrence was accidental, and the teachers immediately applied first aid to child #2.

Please see LIC809-C for Continuation Page.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: AVUSD SITTING BULL ELEMENTARY SCHOOL
FACILITY NUMBER: 364820543
VISIT DATE: 04/24/2024
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Based on LPAs observations and interviews conducted, the facility took appropriate measures to ensure the health and safety of each child. Therefore, no deficiencies will be cited at this time.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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