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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700331
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:23:54 PM

Document Has Been Signed on 06/06/2023 01:23 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:CORNEJO FAMILY CHILD CAREFACILITY NUMBER:
367700331
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Alba Cornejo, ApplicantTIME COMPLETED:
01:30 PM
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On June 6, 2023, Licensing Program Analyst (LPA), Kuliema Calloway conducted a follow up Pre-Licensing Visit to Cornejo Family Child Care. LPA met with Applicant who granted access.

LPA toured the home inside and outside and observed the safety latch was removed from the bathroom door and the security gate was removed to allow access to the bathroom. The ladder to the play structure was moved to a different location. The gates that were gapping on the side were secured with a fabric roping to prevent children from squeezing through to the off-limits field behind the home. LIC 279 B with all children’s names was provided, vehicle registration and insurance are valid to provide transportation.

Applicant was given the Pre-Licensing packet with licensing forms.

As a result of this inspection, the home does meet Title 22 Regulations. The childcare license will be issued upon LPM approval.

Exit interview conducted: A copy of this report, Notice of Site Visit were discussed and left with Alba Cornejo, Applicant.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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