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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750028
Report Date: 04/24/2023
Date Signed: 04/24/2023 01:55:31 PM

Document Has Been Signed on 04/24/2023 01:55 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: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:
04/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Site Director, Erin JonesTIME COMPLETED:
02:08 PM
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Maddox regarding an Immediate Exclusion Order for Antonio Mejia. LPA Maddox met with Site Director, Erin Jones. Upon arrival, LPA Maddox observed 19 preschoolers with 3 Teachers.

During the inspection, LPA Maddox explained the details of the Immediate Exclusion Order. Director stated Antonio Mejia has not been at the facility since 11/01/2022 and how they understood the Immediate Exclusion Order.

In addition to the Immediate Exclusion Order for the facility, Director was provided a copy of the Order of Individual of Immediate Exclusion from all facilities for Antonio Mejia.

An exit interview was conducted, and a copy of this report was provided to the Interim Director on this date. LPA provided the Notice of Site (LIC 9213) form and verified the form was posted prior to concluding the inspection.

A copy of this report must be made available to the public, at the facility site, for three (3) years.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2023
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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