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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750028
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:13:08 AM

Document Has Been Signed on 11/09/2022 11:13 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SBCUSD-KENDALL PRESCHOOLFACILITY NUMBER:
367750028
ADMINISTRATOR:ERIN JONESFACILITY TYPE:
850
ADDRESS:4951 N STATE ST.TELEPHONE:
(909) 730-3674
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
11/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Facility Representative Erin JonesTIME COMPLETED:
11:25 AM
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On November 9, 2022 at 09:30am Licensing Program Analyst (LPA) Zirbes met with facility representative Erin Jones to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self reported unusual incident report (UIR) submitted to the Department on November 3, 2022. The UIR was regarding a potential conduct inimical incident involving staff 1 (S1). LPA advised facility representative that Investigator Williams of the Investigations Branch will be assisting in the case management. Upon arrival, there were 19 preschool age children, one teacher and two aides providing supervision.

During this inspection, LPA reviewed staff files and obtained documentation related to the case management. Furthermore, LPA also completed a safety inspection of the Center, no deficiencies were observed.

Further investigation is required in order to resolve the case management.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative Erin Jones.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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