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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842907
Report Date: 07/06/2023
Date Signed: 07/06/2023 10:52:32 AM

Document Has Been Signed on 07/06/2023 10:52 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
364842907
ADMINISTRATOR:PEREZ, PETRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(442) 285-7175
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
07/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Petra Perez, LicenseesTIME COMPLETED:
11:00 AM
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On July 6, 2023, Licensing Program Analyst (LPA) Calloway made an unannounced case management inspection to the above facility. The purpose of the inspection was to follow up POC deficiency, 102417(d) for the outside playground. LPA met with Licensee and Licensees’ spouse/assistant who granted access. LPA observed 5 children in care and 2 staff.

LPA inspected the play area and observed the wooden ground was covered with artificial turf and a foam padding underneath which provides a safer area for the children to play. Licensee and spouse agreed to monitor and maintain the area so that the turf remains intact and does not lift to cause safety concerns and always provide supervision and separate the age groups during play time.

Exit interview was conducted and a copy of this report was read and provided to Licensee and a Notice of Site Visit were read and provided to Petra Perez, Licensee at the facility.

Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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