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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750169
Report Date: 01/22/2025
Date Signed: 01/22/2025 01:14:16 PM

Document Has Been Signed on 01/22/2025 01:14 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: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: 32DATE:
01/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:35 AM
MET WITH:Rosa Ayala Lopez, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:33 PM
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On 01/22/2025 at 11:35 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 01/17/24. LPAs disclosed the purpose of the inspection. Upon arrival, there are 32 preschool children in care, along with 9 teachers.

Description of Incident: On 01/17/2025, Teacher #1 had to perform a Heimlich Maneuver during lunch time due to child #1 choked on a strawberry. Teacher #1 successfully conducted the Heimlich Maneuver and child #1 resumed to normal activities after the event.

During the inspection, LPAs interviewed Teacher #1 and the Director. Child #1 was not present at the time of inspection. After interviews conducted with Teacher #1, Director, and parent #1 (parent of child #1), it was revealed Teacher #1 took the appropriate measures to ensure the health and safety of child #1. Teacher #1 immediately recognized child #1 was choking and performed a successful Heimlich Maneuver. Director immediately called parent #1, and stated they will monitor child #1 throughout the day. Child #1 continued to eat their food after the event, and went home from the facility around 3:48 PM. LPAs contacted parent #1, and parent #1 corroborated these statements.

No deficiencies have been cited at this time. Director is informed to continue to report any Unusual Incidents to the Palmdale Regional Office within 24 hours.

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: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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