<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805889
Report Date: 03/04/2025
Date Signed: 03/04/2025 01:13:16 PM

Document Has Been Signed on 03/04/2025 01:13 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:SBCSS MOJAVE VISTA STATE PRESCHOOLFACILITY NUMBER:
364805889
ADMINISTRATOR/
DIRECTOR:		NANCY CRUZFACILITY TYPE:
850
ADDRESS:16100 BURWOOD AVENUE ROOM 3TELEPHONE:
(760) 241-4144
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 24TOTAL ENROLLED CHILDREN: 22CENSUS: 17DATE:
03/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:58 PM
MET WITH:Site Supervisor Yasmin JimenezTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/04/2025, Licensing Program Analysts (LPAs) Ana Rodriguez and Carol Heath met with Site Supervisor Yasmin Jimenez to conduct an unannounced case management inspection. The purpose of the case management was to follow up on unusual incident report (UIR) received 02/20/2025. Incident occurred on 02/19/2025, Facility reported that a student tripped and hit the corner of a chair which caused injury to the upper right eyebrow.
Upon arrival, LPAs observed 17 childcare children and 3 teachers providing care and supervision.

During this inspection LPAs conducted interviews with Site Supervisor, Assistant Teacher, and other related parties. LPAs observed 5 childrens file and 4 staff files. In addition, LPAs completed a safety inspection of the facility grounds. During the inspection, LPAs obtained copies of documentation of incident reports, health checks, and facility roster.

Based on the interviews and observation, the incident does not appear to have resulted in any violation of the Tittle 22 regulation. Therefore, no deficiencies were cited.

A notice of site visit was given and must remain posted for 30 days. Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each.

Exit interview conducted with Director Site Supervisor Yasmin Jimenez.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Ana Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1