153801052-8-31-2023-12-CC-APIN-CV8U3F-20230831151329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153801052
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:13:36 PM

Document Has Been Signed on 08/31/2023 03:13 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	CALIFORNIA CITY CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	153801052
ADMINISTRATOR:	GONZALES, YOLANDA		FACILITY TYPE:	850
ADDRESS:	9124 CATALPA AVENUE		TELEPHONE:	(760) 373-7605
CITY:	CALIFORNIA CITY	STATE: CA	ZIP CODE:	93505
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 20	CENSUS: 14	DATE:	08/31/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Lead Teacher Jazmin De La Cruz/Duarte		TIME COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/31/2023 at 12:30pm, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by Teacher Aide Carla Valdivia who permitted entry to the facility. LPA was later met by Lead Teacher Jazmin De La Cruz/Duarte who assisted the LPA on touring the facility according to the facility sketch. Upon arrival, LPA observed 14 preschoolers in care with 4 staff providing care and supervision. During the visit, LPA conducted observations, interviews, and record reviews of the facility. On 8/24/2023, C1 had fallen from the climbing structure injuring their arm in the fall. LPA conducted interviews with relevant parties, reviewed the records from the facility, and the following information was revealed: S1 was supervising the children who were under the tarp in Zone B. C1 was playing on the climbing structure in Zone A on the leaf climber under the supervision of S2. S2 was assisting another preschooler off of the ground who had fallen from the scooter while on the bike trail. It was during that time that C1 was climbing on the climbing structure by themselves. S1 seen as C1 had fallen from the climbing structure and got up holding their arm. S1 called out to C1, C1 walked over to meet S1 as they walked to them asking if C1 was okay. S1 noted that C1 was holding their arms at their sides, in not a normal manner. S1 asked C1 if they were okay and they were making a low noise from their mouth. S1 touched C1 arm as they were holding it abnormally, then C1 began to cry. S1 took C1 to S2 to show the injury that C1 had sustained and believed additional medication attention was immediately needed; it was agreed between S1 and S2 that medical attention would be needed. S1 had taken C1 inside the classroom from the outdoor play area; S1 helped stabilize C1's arm until medical help could be received. S3 had returned from lunch and S1 asked S3 to take a look a the child's arm to assess if additional medication attention would be needed and it was agreed by S1 and S3 to seek medical attention. S3 placed the call to 911 to request paramedic assistance. S1 called to notify the parent of C1 of the injury after the paramedics had been called, P1 arrived when the paramedics had begun treatment on C1. Continue to next page

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: CALIFORNIA CITY CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 153801052
	VISIT DATE: 08/31/2023

NARRATIVE

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On the day of the incident, S2 stated they were able to view the climbing structure and provide supervision of C1 climbing on the climbing structure although S2 was assisting another preschooler that had fallen off the scooter onto the ground. The climbing structure is age-appropriate for the preschoolers enrolled at the facility, for ages two to five years of age. P1 was contacted and provided a statement that they had been informed of the falling injury sustained by C1. P1 was asked if C1 had explained to them what happened in the incident and P1 stated that C1 said they had "...fallen from the playground." P1 was asked if C1 could be interviewed and P1 stated that they would prefer that the statement provided by P1 be used instead.

There were three teachers and one aide providing care and supervision to seventeen preschoolers on the day of the incident, the facility was within ratio; also, during the incident, there were two teachers and an aide provide care and supervision to the preschoolers during play in the outdoor play area. The staff provided assistance to C1 and contacted medical services immediately after the injury. Additionally, the staff promptly notified the parents of C1 of the injury after the incident occurred. And, reporting requirements were met as the administration notified licensing of the incident and completed and submitted the LIC 624 within 7 days of the incident.

As a result, there is no citation being issued for this incident. The staff followed protocol and acted appropriately in providing care and supervision of the preschoolers, the staff sought aide for the injured child promptly, and notified the parents and licensing.

An exit interview was conducted, a copy of this Report, a Notice of Site visit, and Appeal rights were provided and discussed with Lead Teacher Jazmin De La Cruz/Duartee.

All licensing reports are recommended to be kept for 3 years and the Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC809 (FAS) - (06/04)

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