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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750169
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:24:44 AM

Document Has Been Signed on 01/10/2025 11:24 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: 22DATE:
01/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Rosa Ayala Lopez, Director TIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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On 01/10/2025 at 9:30 AM, Licensing Program Analysts(LPAs) Justeene Tamayo and Hanna Cha met with Director, Rosa Ayala Lopez, who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for a UIR received at Palmdale RO on 12/17/24. The center went on Winter Break until the beginning of January, therefore LPA was unable to investigate the UIR at the time of occurence. LPA disclosed the purpose of the inspection. Upon arrival, there are 22 preschool children in care, along with 9 teachers.

Description of Incident: On 12/16/24, Child #1 fell on the playground and scratched the left side of their face. Doctor released child #1 to return to daycare on 12/17/24.

During the inspection, LPAs interviewed staff, children #2-5, and the Director. Child #1 was not present at the time of inspection.

At this time, further investigation is needed. Director was informed a random unannounced inspection will be conducted at a later date to interview child #1.

An exit interview was conducted, a copy of this report was provided to Director, along with her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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