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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411390
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:07:31 PM

Document Has Been Signed on 12/23/2024 03:07 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 CHILDRENS CENTERFACILITY NUMBER:
197411390
ADMINISTRATOR/
DIRECTOR:		MEDINA, NICOLEFACILITY TYPE:
830
ADDRESS:918 W. AVE JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 1DATE:
12/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Assistant Director Aja MintersTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 12/23/2024, Licensing Program Analyst (LPA) Andrea Pittman conducted an unannounced case management visit at the facility and was met by the Facility Representative who permitted entry to the facility. LPA toured the facility with the Assistant Director Aja Minters according to the facility sketch. Upon arrival, LPA observed 1 children present with 3 staff members providing care and supervision.

During this inspection, LPA conducted a followed up on the UIR that was received on 12/20/2024 about an incident on 12/18/2024 that involved Child 1 allegedly injuring their arm at the facility that was reported later as a fracture. LPA interviewed staff, parents, and other relevant parties regarding the incident. Additionally, LPA reviewed the video footage of the infant in the facility on 12/18/2024. LPA reviewed the actions taken by Staff 1, 2, 3, and 4, and found the actions to meet the basic requirements of policy in supervision, first aid provided to an injured child, reporting, etc. Based on the information gathered, there are no reportable violations at this time. LPA provided technical assistance to ensure that the facility continues to report and ensure timely reporting occurs.

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

An exit interview was conducted, and a copy of this report was read and provided to the Assistant Director along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2024
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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