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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750041
Report Date: 01/18/2023
Date Signed: 01/18/2023 02:44:26 PM

Document Has Been Signed on 01/18/2023 02:44 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:APPLE VALLEY CHILD CARE CENTERFACILITY NUMBER:
367750041
ADMINISTRATOR:SHERRY JENKINSFACILITY TYPE:
850
ADDRESS:18609 CORWIN ROADTELEPHONE:
(760) 242-5437
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 62TOTAL ENROLLED CHILDREN: 62CENSUS: 54DATE:
01/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:SHERRY JENKINSTIME COMPLETED:
02:55 PM
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On 01/18/23, Licensing Program Analyst (LPA) Babatunde Ibitoye met with Director Sherry Jenkins, to conduct an unannounced case management inspection to follow up on a self-reported unusual incident report submitted by the facility on 01-17-23. Upon arrival, LPA observed 54 children and 7 staff members.

Description of incident: On 01-17-23 when waking the child up after nap time child 1(C1) was unresponsive. The Director called 911 while the teacher was trying to wake the child, and called the child-parent. It appears that C 1 was having a seizure. Paramedics arrived and they said C 1 has epilepsy. The child was transported to Desert Valley hospital and later transferred to Loma Linda Hospital.

Based on the information gathered from observations, record review, and LPA obtained facility children roster additional follow-up is needed.

An exit interview was conducted, the report was read, and a copy of this report was given to the facility director along with the appeal rights and notice of the site visit.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2023
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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