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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407119
Report Date: 09/26/2023
Date Signed: 09/26/2023 03:58:26 PM

Document Has Been Signed on 09/26/2023 03:58 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:POVERELLO OF ASSISI PRESCHOOLFACILITY NUMBER:
197407119
ADMINISTRATOR:SISTER CATALINA AVILAFACILITY TYPE:
850
ADDRESS:13367 BORDEN AVENUETELEPHONE:
(818) 364-7446
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 25DATE:
09/26/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Sister Catalina Avila, DirectorTIME COMPLETED:
04:10 PM
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On Tuesday, September 26, 2023, at 3:01 p.m., Licensing Program Analysts (LPA’s) Mayra Rivera and Evelyn Garcia conducted an unannounced case management inspection at the facility noted above and met with Director Sister Catalina Avila. The purpose of the inspection was to conduct the required inspection for proper ramps for ambulatory students. LPA Rivera inspected the facility and observed a total of 5 ramps, 3 handicap restrooms. Operating hours for this facility are Monday through Friday from 8:00 a.m., to 6:00 p.m. A fire clearance for ambulatory students was granted on September 21, 2023. Teacher and child ratio were observed, and present staff are fingerprinted cleared.

This facility provides Incidental Medical Services – IMS. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

LPA Rivera observed the facility to be equipped to meet the needs of ambulatory children. A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview was conducted with Director Sister Catalina Avila.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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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