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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415962
Report Date: 03/21/2023
Date Signed: 03/21/2023 01:46:43 PM


Document Has Been Signed on 03/21/2023 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:EMBLEM PRESCHOOL/SAUGUS UNION SCHOOL DISTRICTFACILITY NUMBER:
197415962
ADMINISTRATOR:DIANNA GONZALEZFACILITY TYPE:
850
ADDRESS:22635 ESPUELLA DRIVETELEPHONE:
(661) 294-5300
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:60CENSUS: 0DATE:
03/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ashley King- Assistant PrincipalTIME COMPLETED:
01:45 PM
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On 03/21/2023 Licensing Program Analyst (LPA) Ortega arrived at the Emblem Preschool facility to conduct an annual required inspection. According to Administrator facility has not been providing care since 2020 due to Covid and requested to be placed on inactive status. LPA conducted a Case Management Inspection per facility's request. At the time of arrival LPA did not observe any children in care.

Facility requested to be placed on inactive status due to lack of enrollment. Facility is requesting an inactive status starting 3/21/2023 until 3/21/2024. Facility submitted a request for inactive child care license status with signature dated today, 3/21/2023 a Unusual Incident Report will be submitted to the Palmdale Regional office within 7 days. Facility is aware during inactive status no day care children may be enrolled and cared for until an annual required Inspection is conducted and license is reactivated.

Copy of this report, appeal rights and notice of site visit were provided to licensee.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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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