<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418896
Report Date: 02/02/2023
Date Signed: 02/02/2023 02:21:37 PM

Document Has Been Signed on 02/02/2023 02:21 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:HOWARD FAMILY CHILD CAREFACILITY NUMBER:
197418896
ADMINISTRATOR:HOWARD, EDNA M.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 718-3163
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Edna HowardTIME COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/02/2023, Licensing Program Analyst (LPA) Joselito L. Del Mundo arrived at the facility to conduct a case management inspection. The purpose of the case management visit was to follow-up on a self reported Unusual Incident Report submitted by the facility on 01/30/2023.

During the visit, LPA took a census of the children present, and met with licensee Edna Howard to discuss the reported incident. During the visit, LPA spoke with child 1 and licensee where the incident happen. LPA took photo of school roster, staff roster, and sign in sheet for the day of the incident.

Further investigation is needed.

An exit interview was conducted, a notice of site visit was given to be posted for 30 days.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1