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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411391
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:42:02 PM

Document Has Been Signed on 11/07/2024 04:42 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:
197411391
ADMINISTRATOR/
DIRECTOR:		MEDINA, NICOLEFACILITY TYPE:
840
ADDRESS:918 W. AVE. JTELEPHONE:
(661) 942-0812
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 14DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:05 PM
MET WITH:Director Tammy DamonTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 11/7/2024, 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 Director according to the facility sketch. Upon arrival, LPA observed 14 children with 8 staff member providing care and supervision.

During this inspection, LPA received relevant documents and conducted interviews with relevant parties. LPA was able to observe the school age children and determined that their basic needs are currently being met and personal rights are being followed by the Staff. Technical assistance was provided on the LIC 9040 Form. Due to insufficient evidence at this time, additional information will be needed to complete my findings.

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 Director along with the Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrea Pittman
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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