<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750048
Report Date: 05/08/2023
Date Signed: 05/08/2023 01:10:33 PM

Document Has Been Signed on 05/08/2023 01:10 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:SBCSS BIG BEAR STATE PRESCHOOLFACILITY NUMBER:
367750048
ADMINISTRATOR:NANCY ALVARADO/KIM WEBERFACILITY TYPE:
850
ADDRESS:44500 BALDWIN LANETELEPHONE:
(909) 585-7766
CITY:SUGAR LOAF/BIG BEARSTATE: CAZIP CODE:
92386
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 11DATE:
05/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Facility Representative Maria GonzalezTIME COMPLETED:
01:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On May 8, 2023 at 12:01 p.m., Licensing Program Analyst (LPA) Zirbes met with facility representative
Maria Gonzalez 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 March 17, 2023. The unusual incident report was regarding a potential personal rights
incident involving child 1 (C1). Upon arrival, there were 11 preschool age children, and two staff members providing supervision.

During this inspection, interviews were conducted with staff. In addition, LPA completed a review of two child files. At 12:01 p.m. LPA completed a safety inspection of the Center. No deficiencies were observed.

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

An exit interview was conducted, a copy of this report, and notice of site visit were provided to the Facility Representative.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1