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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419004
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:41:35 PM

Document Has Been Signed on 12/13/2023 04:41 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:HARRY FAMILY CHILD CAREFACILITY NUMBER:
197419004
ADMINISTRATOR:HARRY SHAMIKA A.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 492-6535
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:47 PM
MET WITH:Shamika HarryTIME COMPLETED:
04:40 PM
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On 12/13/2023, at 2:47 P.M., 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 that happened last 11/29/2023.

Licensee provided a copy of the current assistant’s driver's license and children’s roster last 12/08/2023.

During interview with relevant parties, it was determined that parents were notified of the incident.

During the visit, LPA took a census of the children present, and met with licensee Shamika Harry to discuss the reported incident. LPA observed 5 children in care with the licensee providing care and supervision. LPA reviewed the assistant’s file (licensee's spouse) and was found to be complete. Based on records review, licensee’s assistant has current mandated reporter trainings completed on 12/01/2023; CPR/First Aid training was completed on 04/29/2023. Licensee’s assistant has proof of immunization against measles, pertussis, and influenza. Licensee assistant has TB skin test on file.

Licensee also provided a copy of the current vehicle registration and insurance. LPA checked the vehicle used for transportation and it appeared that there was no major damage on the vehicle.

No deficiencies were cited during this inspection.

An exit interview was conducted, Appeal Rights provided, and 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: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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