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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147750002
Report Date: 11/06/2024
Date Signed: 11/06/2024 09:49:14 AM

Document Has Been Signed on 11/06/2024 09:49 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:ICOE- ELM ST STATE PRESCHOOLFACILITY NUMBER:
147750002
ADMINISTRATOR/
DIRECTOR:		KATHLEEN DUNCANFACILITY TYPE:
850
ADDRESS:800 W ELM ST BLDG ATELEPHONE:
(760) 873-5123
CITY:BISHOPSTATE: CAZIP CODE:
93514
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Marie Morris, Lead TeacherTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On November 6, 2024, Licensing Program Analyst (LPA) Crystal Ali met with Marie Morris, 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) 8/29/24. UIR was received 8/30/24. On 8/29/24 at approximately 2:45pm, child#1 was in the play yard and walked onto the sand area and stepped off the curb and fell and hit her head directly on the concrete water value covering. Child had a seizure. Teacher called 911 and parent immediately. Doctor approved the child to return on 8/30/24. Child stayed home and returned to preschool on 9/2/24.

Upon arrival, LPA observed 16 preschool and 2 staff member providing care.

During this inspection LPA reviewed the child records and interviewed two
staff regarding the incident.

No deficiencies have been cited at this time.

Exit interview conducted with Marie Morris 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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