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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493008
Report Date: 07/17/2024
Date Signed: 07/17/2024 03:59:43 PM

Document Has Been Signed on 07/17/2024 03:59 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:MAGIC CAROUSEL MONTESSORI PRESCHOOLFACILITY NUMBER:
197493008
ADMINISTRATOR/
DIRECTOR:		SHIRLEY JOHNSONFACILITY TYPE:
830
ADDRESS:17956 SIERRA HIGHWAYTELEPHONE:
(661) 298-4065
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
07/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Director Shirley JohnsonTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On July 17, 2024, Licensing Program Analyst (LPA) Andrew Alemoh conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone and email on 07/10/2024; this incident was reported timely. LPA spoke with Director Shirley regarding the UIR. LPA toured the facility and took a census of the children. Upon arrival, there were 9 children and 7 staff present today at the facility along with the Director

Description of the incident: An incident on 07/10/2024, licensee called to notify the department that a S1 was forcing infants head down as well as covering their head.

LPA interviewed director and staff, along with obtained a copy of children's files, and obtained a copy of the facility roster.

S1 was been terminated from the facility. A final determination has not been made and further follow up is needed. No citations are being issued on this date. This Unusual Incident was reported timely to the Palmdale Regional Office.

An exit interview was conducted, and a copy of this report was provided to the licensee along with Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Andrew Alemoh
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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