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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806698
Report Date: 04/04/2023
Date Signed: 04/10/2023 10:15:05 AM

Document Has Been Signed on 04/10/2023 10:15 AM - 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:SBCSS PUESTA DEL SOL STATE PRESCHOOLFACILITY NUMBER:
364806698
ADMINISTRATOR:NANCY ALVARADOFACILITY TYPE:
850
ADDRESS:15887 ACADEMY STREETTELEPHONE:
(760) 243-3850
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 18DATE:
04/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Susan ShelterTIME COMPLETED:
11:45 AM
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On April 4, 2023, Licensing Program Analyst (LPA) Kris Diaz made an unannounced Case Management (Incident) Inspection to SBCSS Puesta Del Sol State Preschool. LPA met with Susan Shelter who granted access to the center. At the time of LPAs arrival, there were a total of 18 daycare children present ages 3-5 with the licensee and 2 adults.

The purpose of the Case Management Inspection was to follow up on a self-reported incident report, which was submitted to the Department on March 9, 2023. The incident report involved a child sustaining an injury during recess.

During the inspection, LPA completed confidential interviews with 1 daycare child (C1) and 3 staff, (S1-S3). LPA reviewed the facility records. LPA obtained the facility roster.

A safety inspection was completed where zero deficiencies were noted.

Due to the need to gather additional information, further investigation is needed.

Notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted with site supervisor, Susan Shelter.

The report was discussed and left with the site supervisor.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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