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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750009
Report Date: 03/08/2023
Date Signed: 03/08/2023 12:00:51 PM

Document Has Been Signed on 03/08/2023 12:00 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:BARSTOW HEAD START/STATE PRESCHOOLFACILITY NUMBER:
367750009
ADMINISTRATOR:PAMELA MCQUAINFACILITY TYPE:
850
ADDRESS:1121 W MAIN STREETTELEPHONE:
(888) 543-7025
CITY:BARSTOWSTATE: CAZIP CODE:
92311
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 29DATE:
03/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Tawanda HenryTIME COMPLETED:
12:05 PM
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On March 8, 2023, Licensing Program Analyst (LPA) Babatunde Ibitoye made an unannounced visit for the purpose of delivering findings for the Unusual Incident received on 10/27/2022. LPA Met with Acting Site Supervisor Tawanda Henry. There are 29 day-care children present with 3 teacher and 3 teacher Aide .

Description of incident: On 10/26/22 Teacher #1 observed Child#1 hit her twin brother Child #2 with a wooden block and C#2 sustained a bloody cut approximately 1/4 inch around the corner of his right eye. C#1 was also hitting other children in the class and throwing toys’ T#1 comforted C#2, cleaned, and applied an ice pack to stop the bleeding. C#2 was picked up by the parent.

During this investigation, LPA interviewed staff, C #1, and C#2 parents. Based on interviews with the site supervisor, staff, C #1, and C#2 parent .LPA found according to interviews the facility was in the ratio in the classroom. No personal rights violation was revealed, and No deficiency was cited

Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted and a copy of this report has been signed by and provided to the Acting site supervisor Tawanda Henry, Site Visit and Appeal Rights were given.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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