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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750150
Report Date: 04/04/2024
Date Signed: 04/04/2024 01:27:43 PM

Document Has Been Signed on 04/04/2024 01:27 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ARK ACADEMYFACILITY NUMBER:
197750150
ADMINISTRATOR/
DIRECTOR:		VONDA PERRYFACILITY TYPE:
830
ADDRESS:1146 COMMERCE CENTER DRIVETELEPHONE:
(661) 504-4034
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
04/04/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:04 PM
MET WITH: Vonda PerryTIME VISIT/
INSPECTION COMPLETED:
01:34 PM
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Licensing Program Analyst (LPA) Maddox and Licensing Program Manager (LPM) Deborah Lowe met with Director, Vonda Perry today for the purpose of conducting a case management (CM) inspection. Licensee states she has additional space available outdoors and requesting the play yard be re-evaluated for consideration of a capacity increase.

There is a separate play yard available for Infants, measurements taken today totaled 495, which is not enough space to accommodate the requested capacity of 8 Infants. Director stated she will request a waiver.

LPM and LPA provided guidance and reviewed safe sleep regulations, printed copy was also provided. Director was advised to sign up to receive Provider Information Notices (PIN) and the availability of Provider Webinars.

Director states she will move the tricycle merry-go-round to the PS play yard, LPA is requesting Director send in pictures of this equipment once it's moved.

An exit interview was conducted with the above items discussed, copy of appeal rights and this report was provided to the Director. Final license determination will be made upon the review by the Licensing Program Manger and the approval of the waiver request.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2024
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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