<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910831
Report Date: 10/02/2024
Date Signed: 10/02/2024 01:08:53 PM

Document Has Been Signed on 10/02/2024 01:08 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:PSD/APPLE VALLEY HEAD STARTFACILITY NUMBER:
360910831
ADMINISTRATOR/
DIRECTOR:		DOLORES EDWARDSFACILITY TYPE:
850
ADDRESS:13589 NAVAJO ROADTELEPHONE:
(760) 247-6955
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 117TOTAL ENROLLED CHILDREN: 117CENSUS: 34DATE:
10/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:39 AM
MET WITH:Shannon Rodriguez- Program managerTIME VISIT/
INSPECTION COMPLETED:
01:20 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 October 2nd, 2024 Licensing Program Analyst (LPA) Sherell Braddock conducted a subsequent Case Management inspection to deliver the findings for a self reported unusual incident that, occurred on September 24, 2024. LPA met with Program Manager Shannon Rodriguez to discuss the investigation. The investigation consisted of interviews with relevant parties, including staff, parents and children.

Children interviewed were not intimidated or scared of the teacher who uses a stern elevated voice, however based on the information obtained from creditable interviews, the investigation has revealed that staff 1 handled child 1 roughly, forcing child 1 onto a sleeping cot during nap time and yelled at the child to go to sleep.

Based on the information gathered the facility will be issued a Type B deficiency for personal rights violation for the incident where Staff 1 violated Child 1 personal Rights when she picked up Child 1 and witnesses stated Staff 1 forcefully placed the child on a cot to make the child take a nap. The child did not receive any injury or bruises from the incident.

Upon receipt of the Type B Violation, this report shall be posted for 30 days in addition to the Notice of Site Visit.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: PSD/APPLE VALLEY HEAD START
FACILITY NUMBER: 360910831
VISIT DATE: 10/02/2024
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
26
27
28
29
30
31
32
An exit interview was conducted with program Manager Shannon Rodriguez, and a copy of this report, the notice of site visit, and the appeal rights provided on this day.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 10/02/2024 01:08 PM - It Cannot Be Edited


Created By: Sherell Braddock On 10/02/2024 at 12:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: PSD/APPLE VALLEY HEAD START
FACILITY NUMBER: 360910831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
101223(a)(3)

1
2
3
4
5
6
7
101223(a)(3) Personal Rights
The licensee shall ensure that each child is accorded the following personal rights:
To be free from corporal or unusual punishment...interference with functions of daily living including eating, sleeping.....This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Program Manager will conduct a in person personal rights and strategies during nap time training and email LPA the roster by POC Due Date
8
9
10
11
12
13
14
This requirement is not met as evidenced by: On 09/24/2024 Based on interviews with Staff Child 1 personal right was violated, which poses an immediate Health and Safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Sherell Braddock
LICENSING EVALUATOR SIGNATURE:
DATE: 10/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/02/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3