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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750009
Report Date: 11/04/2022
Date Signed: 11/04/2022 04:00:14 PM

Document Has Been Signed on 11/04/2022 04:00 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:BARSTOW HEAD START/STATE PRESCHOOLFACILITY NUMBER:
367750009
ADMINISTRATOR:PAMELA MCQUAINFACILITY TYPE:
850
ADDRESS:1121 W MAIN STREETTELEPHONE:
(888) 543-7025
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 25DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:29 PM
MET WITH:Magdalena ArraygaTIME COMPLETED:
04:20 PM
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On 11/04/2022 Licensing Program Analyst LPA Babatunde Ibitoye
conducted a Case management incident inspection to follow up on an Unusual Incident
reported to the department on 10/27/2022. LPA spoke with site supervisor Magdalena Arrayga,
Description of the incident: On 10/26/22 Teacher #1 observed C#1 hit her twin brother C#2 with a wooden block and C#2 sustained a bloody cut approximately 1/4 inch around the corner of his right eye. C#1 were also hitting other children in the class and throwing toys.T #1 comforted C#2, cleaned and applied an ice pack to stop the bleeding. C#2 was picked up by parent.
The purpose of the inspection is to conduct interview with site supervisor and staffs that witnesses the incident. Present during the time of this inspection is site supervisor, teacher #1 is not present today. The copy of facility roster, sign in and out sheet for the incident day was collected.
Further investigation is needed, An exit interview was conducted, and a copy of this report was read and provided to site supervisor Magdalena Arrayga along with Notice of Site Visit.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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