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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750105
Report Date: 09/08/2022
Date Signed: 09/08/2022 01:01:09 PM

Document Has Been Signed on 09/08/2022 01:01 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GARDEN PATCH PLAY SCHOOL, THEFACILITY NUMBER:
197750105
ADMINISTRATOR:CHRISTIE COPLEYFACILITY TYPE:
850
ADDRESS:24436 VALLEY STTELEPHONE:
(661) 888-1198
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 41DATE:
09/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Christie Copley, DirectorTIME COMPLETED:
01:20 PM
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On September 8, 2022, Licensing Program Analyst (LPAs) Barbara Beneroso and Andrew Alemoh conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 07/06/2022; this incident was reported timely. LPAs were greeted by director Christie Copley who guided LPAs on a tour of the facility. Upon arrival, there were 41 children and 10 staff present today.

Description of incident: On 07/06/2022
The incident report indicated that child #1 who is enrolled in the pre-school program was playing in the zip line located in the outdoor playground. When C1 got in the zip line, he lost grip of the handle and fell to the ground on his right arm causing a fracture. Based on the information obtained during the interviews conducted with staff and children, it has been determined that C#1’s incident was the result of an accident. Staff #1 and #2 statements indicated that child lost grip of the handles when he got distracted while talking to his cousin. Staff #1 immediately attended child by checking for injuries and applying ice to the on C#1’s arm. Child #1 cried due to the fall and injury but remained alert and conscious. Child #1’s mom was contacted immediately by the director and arrived to the facility shortly after. Mom took C#1 to the doctor where it was determined the child suffered a fracture. No other injuries were found.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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: GARDEN PATCH PLAY SCHOOL, THE
FACILITY NUMBER: 197750105
VISIT DATE: 09/08/2022
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Staff handled the situation accordingly by providing first aid and immediately contacting child #1’s parents. During inspection, LPAs interviewed staff, director and children and obtained images of where the incident occurred and obtained a copy of the facility roster

During this inspection, LPA interviewed staff, director, children, obtained images of where the incident occurred and obtained a copy of the facility roster.

The information obtained during the unusual incident follow up revealed no violations were found.

Facility is encouraged to continue to report incidents that occur in the facility.

An exit interview was conducted, a copy of this report was provided along with the notice of site visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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