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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410439
Report Date: 10/09/2024
Date Signed: 10/09/2024 01:41:14 PM

Document Has Been Signed on 10/09/2024 01:41 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:LEAPS AND BOUNDSFACILITY NUMBER:
197410439
ADMINISTRATOR/
DIRECTOR:
JESSICA KIEFFERFACILITY TYPE:
830
ADDRESS:2026 E. AVENUE QTELEPHONE:
(661) 272-4611
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 8DATE:
10/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:34 AM
MET WITH:Jessica Kieffer, Director TIME VISIT/
INSPECTION COMPLETED:
02:03 PM
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On 10/09/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with Director, Jessica Kieffer, who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 09/19/24. LPA disclosed the purpose of the inspection to the Director. When LPA arrived at the facility there were 8 infants in care, along with 2 teachers.

Description of Incident: On 09/18/24, child #1 fell and dislocated their arm. Per Director, there were 4 infants playing on the carpet area and tripped over each other, which caused a domino effect.

During this inspection, LPA Tamayo interviewed staff and other relevant parties. Staff had initially instructed the infants to use their walking feet to prevent injuries. However, while playing on the carpet, the children collided with each other, causing a domino effect that resulted in child #1 injuring their arm. Teacher #1 witnessed the incident but could not react quickly enough due to its suddenness. After the fall, Teacher #1 promptly picked up child #1, while Teacher #2 assisted by applying an ice pack to the injured arm. The Director immediately contacted parent #1, and child #1 was picked up from the facility. Staff took the necessary steps to ensure that child #1 received appropriate first aid. Child #1 no longer requires a splint, and their arm has fully healed.

Based on the information gathered, this incident has been deemed accidental, with no violations of Title 22 regulations identified. Therefore, no deficiencies will be cited at this time.


An exit interview was conducted, and a copy of this report was read and provided to the Director, along with a copy of her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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