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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840522
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:01:42 PM

Document Has Been Signed on 11/08/2023 02:01 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:CASTRO-GUITERREZ FAMILY CHILD CAREFACILITY NUMBER:
364840522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
11/08/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Olivia Castro-GutierrezTIME COMPLETED:
02:02 PM
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On November 8, 2023, LPA Kris Diaz conducted Plan of Correction visit. LPA was greeted by Licensee, Olivia Castro-Gutierrez who granted access to the home. LPA conducted safety inspection were zero deficiencies were noted. Upon arrival, LPA observed 6 children in care.

The following corrections were verified:
1. Licensee created file for self
2. All children's files contained PM 286 filled out completely.
3. Licensee submitted proof of doctor's appointment for two childcare children and request for exception of immunizations
4. Safe sleep practices implemented for 1 of 2 infants. 2nd infant turned 2 on 10.25.23
5. Individual Infant Sleep Plan (LIC 9227) in 1 of 2 infants files. 2nd infant turned 2 on 10.25.23
6. LPA did not observe any of the prohibited items in the daycare.

LPA will follow-up with Licensing Program Manager (LPM) for update regarding exception request.

A copy of this report, POC letters, and Notice of Site Visit were provided licensee.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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