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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202176
Report Date: 11/01/2024
Date Signed: 11/01/2024 11:52:29 AM

Document Has Been Signed on 11/01/2024 11:52 AM - 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CHRIST LUTHERAN CHURCHFACILITY NUMBER:
191202176
ADMINISTRATOR/
DIRECTOR:		MONICA SANTIAGO-VENEGASFACILITY TYPE:
850
ADDRESS:25816 NORTH TOURNAMENT ROADTELEPHONE:
(661) 259-0302
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 33DATE:
11/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director Monica SantiagoTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On November 1st, 2024, Licensing Program Analyst (LPA) Andrew Alemoh conducted a case management inspection on an Unusual Incident reported to the department by email on 10/31/2024; this incident was reported timely. LPA spoke with licensee/director. LPA toured the facility and took a census of the children. Upon arrival, there were 33 children and 11 staff present today at the facility.

Description of the incident: An incident on 10/25/2024, licensee/director emailed to notify the department that a child #1 and #2 were playing doctor in the classroom to which both children exposed each other to themselves.

LPA interviewed licensee, interviewed staff, obtained a copy of children's files, and obtained a copy of the facility roster.

A final determination has not been made and further follow up is needed. No citations are being issued on this date. This Unusual Incident was reported timely to the Palmdale Regional Office.

An exit interview was conducted, and a copy of this report was provided to the licensee along with Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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