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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419075
Report Date: 04/19/2023
Date Signed: 04/19/2023 12:26:11 PM


Document Has Been Signed on 04/19/2023 12:26 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:PIPHER FAMILY CHILD CAREFACILITY NUMBER:
197419075
ADMINISTRATOR:PIPHER, KAREN LYNNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 373-9650
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:14CENSUS: 0DATE:
04/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Karen Lynn PipherTIME COMPLETED:
10:30 AM
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On 4/19/2023, Licensing Program Analyst(LPA) Isabel Ortega Arrived to the facility, LPA announced the purpose of today's inspection and was granted entry by Licensee. Upon arrival LPA observed 3 children in care. Today's inspection is to change Provider's inactive status to active status. Inactive status ended on 4/15/2023 per inactive request. According to licensee she would like to continue with her License Family Child Care Home(large) and is requesting to be placed back in active status, Licensee called the Palmdale Regional Office on Monday 4/17/2023 and informed she will be back to active status effective 4/17/2023 as scheduled. LPA informed Licensee a complete unannounced Annual Random inspection will be conducted.

License will be placed back on ACTIVE STATUS effective 4/17/2023.

An exit interview was conducted and a copy of this report, appeal rights and Notice of Site Visit(NOA) was provided to the licensee on this date.

A copy of this report must be made available to the public for 3 years. NOA shall be posted for 30 days.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2023
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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