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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197408508
Report Date:
10/26/2022
Date Signed:
10/26/2022 01:14:25 PM
Document Has Been Signed on
10/26/2022 01:14 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:
SULPHER SPRINGS UNION SCH. DIST.-MINT CANYON PRESC
FACILITY NUMBER:
197408508
ADMINISTRATOR:
ESCALANTE, JULIE
FACILITY TYPE:
850
ADDRESS:
16400 SIERRA HIGHWAY
TELEPHONE:
(661) 252-8026
CITY:
CANYON COUNTRY
STATE:
CA
ZIP CODE:
91351
CAPACITY:
24
CENSUS:
DATE:
10/26/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:45 PM
MET WITH:
TIME COMPLETED:
01:00 PM
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SUPERVISOR'S NAME:
Mariela Ramon
TELEPHONE:
(661) 202-3798
LICENSING EVALUATOR NAME:
Barbara Beneroso
TELEPHONE:
(661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE:
10/26/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/26/2022
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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