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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801387
Report Date: 11/01/2023
Date Signed: 11/01/2023 04:27:33 PM


Document Has Been Signed on 11/01/2023 04:27 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:GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
153801387
ADMINISTRATOR:ARNECKE, KRISTENFACILITY TYPE:
830
ADDRESS:329 SOUTH MILL STREETTELEPHONE:
(661) 823-7740
CITY:TEHACHAPISTATE: CAZIP CODE:
93561
CAPACITY:10CENSUS: 8DATE:
11/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Parks, MadisannTIME COMPLETED:
02:00 PM
NARRATIVE
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On 11/01/2023 LPA Beneroso conducted an unannounced Case Management - Deficiencies Inspection at the facility and was greeted by Director, Ms. Madisann Park who permitted entry to the facility. LPA toured the facility with Ms. Parks according to the facility sketch.  Upon arrival, LPA observed 8 infants with 3 staff member providing care and supervision. The purpose of the inspection is to ensure the health and safety of the infants and the compliance with Tittle 22 regulations.

At approximately 01:19 PM, LPA observed Infant #1 sleeping in a swing. This represents an immediate health and safety risk for the infants in care. A type A Violation was issued for this deficiency. During visit, director Parks, removed the child swings in the infant classroom and moved Infant #1 in a crib.

The facility was cited One-Type-A deficiency as of result of the violation in accordance with Title 22 of the California Code of Regulations. Facility was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of the licensing report must also be posted for 30 days. The same report must be provided to parents/guardians of infants currently and newly enrolled at the facility during the next 12 months and facility must obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian and place it in each infant’s file. If these requirements are not met, civil penalties per violation will be assessed.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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 2


Document Has Been Signed on 11/01/2023 04:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: GOOD SHEPHERD PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 153801387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2023
Section Cited
CCR
101430(a)(3)(E)

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101430(a)(3)(E) Infant Care Activities. If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible. This requirement was not met as evidenced by: LPA observed one infant in carel asleep in a swing
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LPA observed director remove child swing from the classroom during visit and placed infant in a crib. Per director, she also agrees to provide training to staff regarding Infant Safe Sleep. Proof of this training must be submitted to LPA Beneroso no later than 11/14/2023
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The staff did not take action to move the infant to a crib or play yard as soon as as child fell asleep. This is an immediate risk to the health, safety or personal rights risk to the infants in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2