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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801420
Report Date: 12/27/2022
Date Signed: 12/27/2022 10:22:52 AM


Document Has Been Signed on 12/27/2022 10:22 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:ARVIN STATE PRESCHOOLFACILITY NUMBER:
153801420
ADMINISTRATOR:MAGDALENA HERNANDEZFACILITY TYPE:
850
ADDRESS:633 WALNUT DRIVETELEPHONE:
(661) 854-6580
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:48CENSUS: DATE:
12/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:TIME COMPLETED:
10:25 AM
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On 10/27/22 LPA Beneroso attempted to do an annual visit at Arvin State Preschool but was unsuccessful.
LPA contacted the number on file but the phone just rang. The gates are closed and there is no option to leave business card by the door.

LPA will attempt to do another visit after the new year.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 12/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/27/2022
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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