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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750169
Report Date: 04/23/2024
Date Signed: 04/23/2024 11:51:38 AM

Document Has Been Signed on 04/23/2024 11:51 AM - 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:CCRC LPC HEAD STARTFACILITY NUMBER:
197750169
ADMINISTRATOR/
DIRECTOR:		BETTY ZAMORANO PEDREGONFACILITY TYPE:
850
ADDRESS:2320 EAST AVENUE RTELEPHONE:
(661) 273-0608
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 18DATE:
04/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:32 AM
MET WITH:Rosa Lopez, DirectorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 04/23/2024, Licensing Program Analyst (LPA) Justeene Tamayo met with Site Director Rosa Lopez, for a Case Management Incident inspection involving an Incident Report dated 04/15/2024. Upon arrival, LPA observed 18 preschool children in care.

Description of the incident: On 04/15/24 around 9:30AM, child #1 seemed lethargic, and the facility called 911. Child #1 was transported to the hospital.

From interviews conducted at the facility, staff #1 conducted a health and safety check of child #1 prior to child #1 being checked in for class. Parent #1 was with the child at the time of when the incident occurred. Based on documentation obtained and interviews conducted, 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 Director Rosa Lopez, as well as her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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