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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808720
Report Date: 04/04/2024
Date Signed: 04/04/2024 11:04:22 AM

Document Has Been Signed on 04/04/2024 11:04 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:AVUSD RANCHO VERDE STATE PRESCHOOLFACILITY NUMBER:
364808720
ADMINISTRATOR/
DIRECTOR:		MICHELLE PONCEFACILITY TYPE:
850
ADDRESS:14334 PIONEERTELEPHONE:
(760) 240-4732
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
04/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH: Shelly SalasTIME VISIT/
INSPECTION COMPLETED:
11:07 AM
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On April 4, 2024, at 09:45 a.m., Licensing Program Analysts (LPAs) Braddock and Diaz met with facility representative, Shelley Salas who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 3/28/24. LPA disclosed the purpose of the inspection to the facility representative. When LPAs arrived at the facility there were 16 children in care with 4 staff. The hours of operation for the program are 8:15am -11:15am for the am program and 12:15pm – 3:15pm for the pm.

During the inspection LPA obtained a roster of children present on the day of the incident and interviewed staff present and child involved.

LPA completed a safety inspection of the facility at approximately 10:42 a.m.

Based on LPAs observations zero citations were observed or issued today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility representative.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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