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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814430
Report Date: 02/01/2023
Date Signed: 02/01/2023 01:13:38 PM


Document Has Been Signed on 02/01/2023 01:13 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 YUCCA VALLEY HEAD STARTFACILITY NUMBER:
364814430
ADMINISTRATOR:LUGENE SPRINGFIELDFACILITY TYPE:
850
ADDRESS:56389 PIMA TRAILTELEPHONE:
(760) 369-7424
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:48CENSUS: 33DATE:
02/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Facility representative Edna DayTIME COMPLETED:
01:30 PM
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On February 1, 2023 at 12:30pm Licensing Program Analyst (LPA) Zirbes met with facility representative Edna Day to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report (UIR) submitted to the Department on December 15 2022. The unusual incident report was regarding a child 1 (C1) receiving medical attention at the Center. Upon arrival, there were 33 preschool age children, six teachers and two addition staff at the facility.

During this inspection, interviews were conducted with staff. In addition, LPA reviewed the facility records, and child files. Furthermore, LPA also completed a safety inspection of the Center.

Based confidential interviews and record review at this time, the incident does not appear to have been the result of a violation of the Title 22 regulation.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative Edna Day.




SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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