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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818001
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:51:14 PM

Document Has Been Signed on 02/01/2023 03:51 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:NELSON FAMILY CHILD CAREFACILITY NUMBER:
364818001
ADMINISTRATOR:NELSON, LILLIAN & EARLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 951-5002
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
02/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lillian Nelson, LicenseeTIME COMPLETED:
03:50 PM
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On February 1, 2023, at 2:00 PM Licensing Program Analysts (LPA's) Kristina Diaz and Kuliema Calloway made an unannounced inspection to the facility Nelson Family Child Care Home, for the purpose of conducting a case management inspection to address concerns regarding an unusual incident that was received on January 31, 2023 stating the following:

"On 1/24/23, C1 and C2 got off the bus from school at 2:15 PM and was transported to daycare. Kids were in the play room with staff. Kids were playing in the play room running around. C2 alerted staff that she was touched in her private area by C1. C2's mother was contacted immediately as well as C1's mother.
Location 13284 Via Palma Rd, Victorville, CA 92392 Time occurred approximately 2:30 - 3:00 P.M.

LPA's arrived and observed (1) staff and (3) children in care.

LPA's obtained a copy of the child care facility roster. IB will conduct a further investigation.

Exit interview was conducted with the S2 and a copy of this report, notice site visit, and appeal rights were left at the faciltiy with S2.


LPA Kris Diaz (661) 202-3372
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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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