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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840360
Report Date: 12/19/2023
Date Signed: 12/19/2023 01:13:42 PM

Document Has Been Signed on 12/19/2023 01:13 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: 18DATE:
12/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Tammy Austin, Lead Teacher TIME COMPLETED:
01:30 PM
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On 12/19/2023, Licensing Program Analyst (LPA) Justeene Tamayo met with Associate Teacher Tammy Austin who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident Follow Up Inspection for an Unusual Incident that occurred on 10/25/23. The Unusual Incident was self reported within the time frame specified by regulations. Upon arrival, LPA observed 18 preschool children in care, along with 1 teacher and 2 teacher associates.

Description of incident: On 10/25/23, at 2:40PM child #1 was walking up the steps to go on the slide and tripped on the steps and hit their upper lip which caused minor bleeding to the lip.

From interviews conducted with staff and child #1, staff #1 took appropriate measures and applied ice to child #1 lip in a timely manner, parent was notified, and the fall was accidental. No doctors visit was needed.

No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was read and provided to Tammy Austin, 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: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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