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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910831
Report Date: 05/24/2019
Date Signed: 05/24/2019 01:30:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:PSD/APPLE VALLEY HEAD STARTFACILITY NUMBER:
360910831
ADMINISTRATOR:DOLORES EDWARDSFACILITY TYPE:
850
ADDRESS:13589 NAVAJO ROADTELEPHONE:
(760) 247-6955
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:117CENSUS: DATE:
05/24/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Deanna Cook-ScalesTIME COMPLETED:
01:29 PM
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Licensing Program Analyst (LPA) Claretta Yates conducted an unannounced inspection at the PSD/Apple Valley Head Start and met with Deanna Cook-Scales (Teacher 3). The purpose of the visit was to discuss the Case Management-Incident Report dated 05/03/19.

On 05/03/19 The Child Care Center was assessed an Immediate Civil Penalty of $500.00 for Personal Right Violation Section CCR 102423(a)(1). Based on additional documents obtained The Department is rescinding the $500.00 Immediate Civil Penalty, as well as correcting the citation 102423(a)(1) to reflect the correct citation of 101223(a)(3).

Exit interview conducted: A copy of this report, notice of site visit was discussed and left with Deanna Cook-Scales (Teacher 3).
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Claretta YatesTELEPHONE: (661) 568-8081
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
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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