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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750001
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:42:04 PM

Document Has Been Signed on 01/28/2025 01:42 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SHIN'S FAMILY MARTIAL ART CTRFACILITY NUMBER:
197750001
ADMINISTRATOR/
DIRECTOR:		SHIN, NANCYFACILITY TYPE:
840
ADDRESS:27935 SMYTH DRIVETELEPHONE:
(661) 713-8742
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: DATE:
01/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Nicole VizcarraTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On 1.28.25, Licensing Program Analyst (LPA) Kris Diaz conducted an unannounced visit at the facility to follow up on a UIR received at PRO on 1.16.25. LPA was greeted by Director, Nicole Vizcarra who granted access to the facility. At the time of the visit there were no children present.

LPA was provided the facility roster and documents pertinent to the incident. LPA interviewed the director regarding the incident. At this time LPA more investigation is needed.

This report was read and a copy left with the Director, Nicole Vizcarra. Notice of Site Visit and Appeal Rights were provided. Exit interview conducted.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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