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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409137
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:06:59 AM

Document Has Been Signed on 01/17/2024 11:06 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:NOTRE DAME INFANT CENTERFACILITY NUMBER:
197409137
ADMINISTRATOR:ANGELICA RODRIGUEZFACILITY TYPE:
830
ADDRESS:21704 GOLDEN TRIANGLE RD.#120TELEPHONE:
(661) 255-0053
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 18DATE:
01/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Angelica Rodriguez, DirectorTIME COMPLETED:
11:10 AM
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On Wednesday, January 17, 2024 Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced case management inspection and met with Director Angelica Rodriguez. LPA entered classroom infant 1 and observed 8 infants with 4 staff present. LPA entered the toddler classroom and observed 10 toddlers with two staff present. During this visit, LPA Rivera reviewed the plan of correction to ensure the facility is within infant ratio. LPA observed qualified staff present with the assistants and LPA observed a month worth of daily schedules created by the director that shows how many children are present in each classroom, the staff and the schedule of staff coming in and taking breaks. This schedule ensures that there is active supervision and ratio being met. LPA Rivera cleared the Type B citation.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, during which this report and the Appeal Rights were discussed with Director Angelica Rodriguez.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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