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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201899
Report Date: 09/07/2022
Date Signed: 09/08/2022 08:55:07 AM


Document Has Been Signed on 09/08/2022 08:55 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:LANCASTER UNITED METHODIST CHURCH PRE SCHOOLFACILITY NUMBER:
191201899
ADMINISTRATOR:DAMON, TAMMYFACILITY TYPE:
850
ADDRESS:918 WEST AVENUE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:58CENSUS: DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Tammy Damon TIME COMPLETED:
04:45 PM
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 On 09/07/2022, at 12:43 p.m. Licensing Program Analysts (LPA) Esequiel Rodriguez conducted an unannounced annual inspection at the Facility to provide facility evaluation reports that the LPA was not able to provide (printer failure) in a previous inspection visit conducted on 08/06/2022,

During today's inspection, the LPA went over the reports and provided copy of those documents to Director, Tammy Damon.

No deficiencies cited.

Copy of this report was provided to Ms. Damon and an exit interview conducted. .
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (661) 202-3314
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (661) 202-3321
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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