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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750169
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:10:49 PM

Document Has Been Signed on 01/29/2024 03:10 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:CCRC LPC HEAD STARTFACILITY NUMBER:
197750169
ADMINISTRATOR:BETTY ZAMORANO PEDREGONFACILITY TYPE:
850
ADDRESS:2320 EAST AVENUE RTELEPHONE:
(661) 273-0608
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 15DATE:
01/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosa Ayala-Lopez, Site SupervisorTIME COMPLETED:
03:30 PM
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On 1/29/2024, Licensing Program Analyst (LPAs) Annelise Villa and Crystal Ali met with Site Supervisor Rosa Ayala-Lopez, who guided LPA on a tour of the facility. The purpose of this visit was to conduct a follow up Case Management - Incident inspection for an Unusual Incident that was received by the Department on 1/23/2024. The Unusual Incident was self reported within the time frame specified by regulations. Upon arrival, LPA observed 15 preschool children, with 5 staff present, and the site supervisor.

Description of incident: On 1/22/2024, Child #1 ran from their classroom to the facility's outer gate. While Staff #1 was attempting to stop the child from running into the parking lot, Child #1 abruptly stopped, causing a collision with Staff #1. Due to the height difference, Child #1 hit their head on the Staff #1's knee. Child sustained a cut and bruising around the eye area.

After interviews conducted with staff, it was revealed Staff #1 and licensee observed the incidents occur on 1/22/2024 and it was accidental. Child #1 did not need medical attention, and the licensee took appropriate measures to ensure the health and safety of each child. Per Site Supervisor, the facility is working with staff and parents to ensure similar incidents do not occur.

No deficiencies are being cited at this time.

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

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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