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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 147750002
Report Date: 01/21/2025
Date Signed: 01/21/2025 02:01:46 PM

Document Has Been Signed on 01/21/2025 02:01 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: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: 14DATE:
01/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:11 PM
MET WITH:Nicholas Alfonso, Teacher AidTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On 1/21/25, Licensing Program Analyst (LPA) Crystal Ali met with Teacher Aid Nicholas Alfonso to conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received 1/14/25. Incident occurred on 1/13/25, child was observed by teacher to have three scratch marks on neck.

Upon arrival, LPA observed 14 preschool children all napping and 1 staff providing care. At 1:35pm, lead teacher (Marie Morris) arrived to facility from her break.

During this inspection LPA conducted interviews with staff. In addition, during the inspection, LPA requested copies of LIC 9040 and LIC 500 via phone with Program Manager, Peggy Lindsay. Program Manager will provide the documents via email by end of today. LPA verified 1 staff employee file. The staff file is in compliance.

No further investigation is required for this UIR, facility responded and complied with Title 22 regulations on reporting.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Lead Teacher, Marie Morris.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Crystal Ali
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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