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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191230246
Report Date: 04/12/2024
Date Signed: 04/12/2024 01:36:47 PM


Document Has Been Signed on 04/12/2024 01:36 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:PALMDALE U.S.D./YUCCA ELEMENTARYFACILITY NUMBER:
191230246
ADMINISTRATOR:DR. MELANIE CULVERFACILITY TYPE:
850
ADDRESS:38440 2ND ST. EASTTELEPHONE:
(661) 272-2284
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:124CENSUS: 66DATE:
04/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Christine Burton, Assistant AdministratorTIME COMPLETED:
02:00 PM
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On 04/12/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with Assistant Administrator Christine Burton, for a Case Management Incident inspection involving an Incident Report dated 03/29/2024. Upon arrival, LPA observed 66 preschool children in care.

Description of the incident: Child #1 had an allergic reaction after lunch, and the facility called 911. Child #1 was transported to the hospital.

Based on food allergy documentation obtained, interviews conducted with staff, child #1, and parent #1, the facility took appropriate measures to ensure the health and safety of child #1. Facility complied with Title 22 regulations. No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was read and provided to Assistant Christine Burton, as well as her appeal rights and Notice of Site Visit.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024
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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