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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700549
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:41:44 PM

Document Has Been Signed on 10/23/2024 02:41 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:YANEZ FAMILY CHILD CAREFACILITY NUMBER:
197700549
ADMINISTRATOR/
DIRECTOR:		MARISELA YANEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 878-4089
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Marisela Yanez, LiceseeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On March 18, 2022, Licensing Program Analyst (LPA) Annelise Villa met with Licensee Marisela Yanez for the purpose of following up on an Unusual Incident Report that occurred on October 10, 2024 and was reported to the Department on January 20,2022. Upon arrival LPA observed 9 daycare children with Licensee and 1 staff caring for them.

The incident reported occurred on October 10, 2024 at approximately 3:20 pm when Licensee was observing children playing outside. Child #1 was playing going down the slide and ran to the playhouse nearby. As Child #1 rounded the corner of the playhouse, Child #1 tripped and the child fell on their knee. Licensee was standing approximately 5 feet away. First aid was immediately given and parents were notified in a timely manner. Child #1 returned to the facility the following week.

Based on information provided and interviews conducted the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore no deficiencies were cited.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Annelise Villa
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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