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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201899
Report Date: 06/21/2023
Date Signed: 06/21/2023 01:35:43 PM

Document Has Been Signed on 06/21/2023 01:35 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:LANCASTER UNITED METHODIST CHURCH PRE SCHOOLFACILITY NUMBER:
191201899
ADMINISTRATOR:MEDINA, NICOLEFACILITY TYPE:
850
ADDRESS:918 WEST AVENUE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 43DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Director Nicole MedinaTIME COMPLETED:
02:00 PM
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On 6/21/2023 at 11:45am, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced visit for a case management. The LPA disclosed the purpose of the inspection and was granted entry by the Director, Nicole Medina. Upon entry to the facility, the LPA observed 43 child in care and 8 Staff providing care and supervision (fingerprint cleared and associated to the license).

The purpose was made known to the Director Nicole Medina and the Director assisted the LPA in gathering the information needed during the visit.

All licensing reports are recommended to be kept for 3 years.

An exit interview was conducted, a copy of the report and the Notice of Site visit was read and provided to the Director. The Notice of Site visit is to be posted and visible to parents for 30 days.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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