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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808551
Report Date: 02/22/2024
Date Signed: 02/22/2024 10:58:19 AM

Document Has Been Signed on 02/22/2024 10:58 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:FALLER STATE PRESCHOOLFACILITY NUMBER:
153808551
ADMINISTRATOR:MICHELLE A ARMSTRONGFACILITY TYPE:
850
ADDRESS:1500 WEST UPJOHNTELEPHONE:
(760) 499-1694
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 20DATE:
02/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Teri Briant, Preschool/Admin SupportTIME COMPLETED:
11:00 AM
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On February 22, 2024, Licensing Program Analysts (LPAs) Crystal Ali and Justeene Tamayo met with Teri Briant (preschool/admin support) and Lizet Robles (site supervisor) conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received 1/29/24. Incident occurred on 1/26/24 at 3:25pm, child#1 was running with friends and tripped over their feet and fell and hit their head on the pole, and sustained a knot on head and black eyes.

Upon arrival, LPAs observed 20 preschool children and 5 staff members providing care.

During this inspection LPAs required for facility to purchase padding (4ft tall) for the 4 metal poles in the playground (located where the anchored play equipment is under the shade structure) to prevent this incident from reoccurring. The site supervisor and preschool support staff where informed of this requirement. Per Teri Briant, the padding will be purchased and completed by 3/21/24. Facility representative will email LPA Ali the proof of completion.

No deficiencies have been sited at this time.

Exit interview conducted with Teri Briant, along with her appeal rights, 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: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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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