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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 144803397
Report Date: 11/06/2024
Date Signed: 11/06/2024 09:08:16 AM

Document Has Been Signed on 11/06/2024 09:08 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ICSS - BISHOP KIDS CLUB STATE PRESCHOOLFACILITY NUMBER:
144803397
ADMINISTRATOR/
DIRECTOR:		KAT DUNCANFACILITY TYPE:
850
ADDRESS:800 W. ELM ST., BLDG. BTELEPHONE:
(760) 873-5436
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 10DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Eleanor Woodall, Lead Teacher/Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
09:10 AM
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On November 6, 2024, Licensing Program Analyst (LPA) Crystal Ali met with Eleanor Woodall lead teacher/site supervisor, conduct an unannounced case management inspection. The purpose of the case management (CM) was to follow up on unusual incident report (UIR) 11/5/24. UIR was reported to LPA in person on 11/6/2024 by Eleanor. On 11/5/24 at approximately 4:30pm, child#1 was sitting halfway on his chair while playing at the table. The chair fell from under the child and the child hit his nose hard on the edge of the table. The child nose was bleeding, teacher applied first aid. Child mom arrived a few minutes after incident happened and took child to the hospital. Child has a broken nose. Child did not return to preschool today.

Upon arrival, LPA observed 10 preschool and 2 staff member providing care.

During this inspection LPA received a copy of facility child roster (LIC 9040). LPA interviewed Eleanor Woodall regarding this incident.

No deficiencies have been cited in accordance with Title 22 and Health and Safety Code.

Exit interview conducted with Eleanor Woodall and Notice of Site Visit. Notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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