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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409614
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:46:00 PM


Document Has Been Signed on 06/12/2024 01:46 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CREATIVE YEARS NURSERY SCHOOLFACILITY NUMBER:
197409614
ADMINISTRATOR:DENISE BAYLISSFACILITY TYPE:
850
ADDRESS:21710 GOLDEN TRIANGLE ROADTELEPHONE:
(661) 254-0718
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:187CENSUS: 32DATE:
06/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Katri Tyni, Administrator.TIME COMPLETED:
01:55 PM
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On Wednesday, June 12, 2024 at 10:20 am, Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management in regards self reporting unusual incident that occurred on June 5, 2024, potential personal rights. The department received the written report on June 10, 2024. The purpose of this visit is to follow up in regards the incident.

Upon arrival, LPA Rivera observed 32 preschool children and 4 staff members on the playground providing care.

During this inspection LPA conducted interviews with 3 children, and 1 staff. In addition, during the inspection, LPA obtained copies of relevant documentation and facility roster.

Due to the need to gather additional information, the case management will require further investigation.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with administrator Katri Tyni.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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