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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700583
Report Date: 02/08/2024
Date Signed: 02/13/2024 02:57:59 PM

Document Has Been Signed on 02/13/2024 02:57 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:JEAN NOEL FAMILY CHILD CAREFACILITY NUMBER:
197700583
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
02/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Greitchy Jean NoelTIME COMPLETED:
04:43 PM
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On 02/08/2024, at 2:38 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 (UIR) that happened on 02/05/2024 at the facility. LPA met with Licensee, Greitchy Jean Noel. The investigation included an inspection of the facility where the incident occurred, a review of facility records, and confidential interview with the licensee.

LPA observed four children with the licensee providing care and supervision. LPA obtained a copy of the children’s roster and sign in and out sheet for the child.

During the interview with the licensee, it was determined that paramedics were called, and parents were notified of the incident. Paramedics came and checked the child’s vital signs. Afterwards, child was taken to the hospital. A few days after the incident, parent provided licensee with medications to be stored in the child’s bag in cases of emergencies. Licensee was reminded to store the bag in a place inaccessible to children in care. Licensee also stated that before the drop off and after picking up the child, parent was administering the medications. Licensee was advised to send a copy of the Incidental Medical Services Plan to LPA.

During today’s visit, Licensee was made aware of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing on the day of the incident and/or 24 hours of incident by telephone, fax and/or in writing to the Department. Licensee is familiar with the Unusual Incident Report form, LIC624B. The report on unusual incident/injuries can also be mailed to unusualIncidentreport@dss.ca.gov.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: JEAN NOEL FAMILY CHILD CARE
FACILITY NUMBER: 197700583
VISIT DATE: 02/08/2024
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Licensee was also reminded of the duty worker. The Duty Worker is available for questions from Monday through Friday, at phone number (661) 202-3318, from 8:00 A.M. to 5:00 P.M.

No deficiencies were cited during this inspection.



A LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.

An exit interview was conducted, Appeal Rights and a copy of this report were provided to licensee, Greitchy Jean Noel.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC809 (FAS) - (06/04)
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