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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911142
Report Date: 11/15/2022
Date Signed: 11/15/2022 03:11:27 PM


Document Has Been Signed on 11/15/2022 03:11 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:PSD/VICTORVILLE HEAD STARTFACILITY NUMBER:
360911142
ADMINISTRATOR:LUCY ANGELA NARANJOFACILITY TYPE:
850
ADDRESS:14029 AMARGOSA ROAD, STE. CTELEPHONE:
(760) 245-9147
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:95CENSUS: 5DATE:
11/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Keosha Smith, Site SupervisorTIME COMPLETED:
03:30 PM
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On November 15, 2022, at 2:00 PM., Licensing Program Analysts (LPA’s), Kuliema Calloway and Babatunde Ibitoye made an unannounced inspection to the facility PSD/ Victorville Head Start and met with Keosha Smith (S1), Site Supervisor for the purpose of conducting a Case Management inspection to address concerns regarding an incident report that was received on 11/9/2022 stating the following:

On 11/9/2022, CCLD received a call from S1 stating the heater was malfunctioning in classroom EHS 94. The staff had portable heaters for the day but the unit will be fixed on 11/10/22. No child was affected by this incident.

LPA observed five (5) children in care and two (2) staff members inside the classroom. LPA obtained a copy of the classroom roster and a copy of the work order. LPA interviewed Staff: S1, S2, and S3 in person during today's inspection. [See confidential names list dated 11/15/2022]. Based on the interviews conducted and information obtained during today's inspection, there is additional information needed at this time.

Exit interview was conducted with the S1 and a copy of this report and appeal rights were left at the facility

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022
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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