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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750041
Report Date: 04/30/2024
Date Signed: 04/30/2024 01:23:02 PM

Document Has Been Signed on 04/30/2024 01:23 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PALMDALE SCHOOL DISTRICT-MANZANITA HEAD STARTFACILITY NUMBER:
197750041
ADMINISTRATOR/
DIRECTOR:		DR. MELANIE CULVERFACILITY TYPE:
850
ADDRESS:38620 33RD STREET EASTTELEPHONE:
(661) 266-7804
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 32DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:34 PM
MET WITH:Joe Vega, School Readiness Coordinator TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 04/30/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with School Readiness Coordinator Joe Vega, for a Case Management Incident inspection involving an Incident Report dated 04/17/2024. Upon arrival, LPA observed 32 preschool children in care.

Description of the incident: On 04/17/2024, during outside play time, child #1 was running to sit at the table when child #1 slipped and hit their forehead on the table. Child #1 sustained a laceration above the left eye.

Based on interviews conducted with staff and parent #1, the facility took appropriate measures to ensure the health and safety of child #1. Facility complied with Title 22 regulations. No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was read and provided to Joe Vega, as well as his appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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