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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413768
Report Date: 12/21/2023
Date Signed: 12/22/2023 09:41:55 AM


Document Has Been Signed on 12/22/2023 09:41 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/22/2023 09:26 AM

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

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On 12/22/2023 LPA Alemoh amended the report to make the following corrections to the report. The day of the incident occurred on the 14th of December, and was reported to the licensing department on the 15th of December.

On 12/21/2023, Licensing Program Analyst Andrew Alemoh met with Director Ruby Trejo for the purpose of following up on an unusual incident report submitted to the Department on 12/15/2023. During the visit, LPA toured the facility and took a census of the children present. LPA observed 28 toddlers with 3 staff members providing supervision.

The incident report indicated that during the morning when the children were being transported to school when another vehicle scrapped the side of the bus. At the roundabout another car tried to get in front of the school bus and scrapped the side of the school bus. The school bus immediately pulled over and informed the Directors.
Based on the information obtained during the interviews conducted with directors, staff, and children, it has been determined that no children were harmed during the cause of the minor incident. Children's statements collaborated with Director’s statements indicated that the Team Lead was sent out to pick up the children in another bus and to drop them off at school. Assistant Director immediately contacted Director and District Manager and the parents were notified of the incident. Staff also provided parents with a written incident report.
The information obtained during the unusual incident follow up revealed no violations were found.
Facility is encouraged to continue to report incidents that occur in the facility.
An exit interview was conducted, a copy of this report was provided along with the notice of site visit.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrew AlemohTELEPHONE: 661-202-3365
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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