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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840360
Report Date: 05/23/2023
Date Signed: 05/23/2023 03:04:05 PM

Document Has Been Signed on 05/23/2023 03:04 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:AVUSD VANGUARD STATE PRESCHOOLFACILITY NUMBER:
364840360
ADMINISTRATOR:RENEE THOMASFACILITY TYPE:
850
ADDRESS:12951 MESQUITE ROADTELEPHONE:
(760) 247-2052
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
05/23/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Patricia FullerTIME COMPLETED:
03:45 PM
NARRATIVE
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On May 23, 2023, Licensing Program Analyst (LPA) Babatunde Ibitoye conducted a follow-up case management inspection and met with the lead Teacher Patricia Fuller. The purpose of the inspection was to deliver findings for the Case management Inspection/complaint allegation.

Based on LPA observations, physical evidence, and interviews, it was determined that the Facility failed to report to CCLD and the parents of the program regarding the incident that occurred on 4/27/2023 about the day-care child found medication at the facility. The facility did not notify the Department by telephone or in writing within the mandated time frame.

Based on the information obtained, there is a preponderance of evidence to prove that the Facility failed to meet the reporting requirements. Therefore, Type B deficiencies are being cited. See LIC 809 D for deficiencies.

An exit interview is conducted, and a copy of this report, appeal rights, and notice of the site visit are discussed with Lead Teacher Patricia Fuller.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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Document Has Been Signed on 05/23/2023 03:04 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 05/23/2023 at 02:25 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: AVUSD VANGUARD STATE PRESCHOOL
FACILITY NUMBER: 364840360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2023
Section Cited
CCR
101212(d)(C)

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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 1.the school will be cleaned every morning/ afternoon,prior to children arrival time. the teacher will checks the classroom each morning and afternoon before children arrive for health and safety precautions
2. Also the facility will clean the entry place and play ground each morning and afternoon before children arrive.
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Based on observation, interviews, and record review, the Facility did not report to Palmdale Regional Office in a timely manner which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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:Claretta Yates
LICENSING EVALUATOR NAME:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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