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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807987
Report Date: 10/24/2022
Date Signed: 10/24/2022 04:25:58 PM

Document Has Been Signed on 10/24/2022 04:25 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:SBCUSD-BRADLEY PRESCHOOLFACILITY NUMBER:
364807987
ADMINISTRATOR:AMY COKERFACILITY TYPE:
850
ADDRESS:1300 VALENCIA AVENUETELEPHONE:
(909) 388-6317
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 36TOTAL ENROLLED CHILDREN: 22CENSUS: 10DATE:
10/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Facility Representative Emily AguilarTIME COMPLETED:
04:35 PM
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On October 24, 2022 at 3:16pm Licensing Program Analyst (LPA) Zirbes met with Facility Representative Emily Aguilar to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report (UIR) that occurred on September 9, 2022. The unusual incident report was regarding a potential personal rights incident involving child 1 (C1). Upon arrival, there were 10 preschool age children, and one teacher and two aides providing supervision at the facility.

During this inspection, confidential interviews were conducted with staff. In addition, LPA reviewed staff files and obtained documentation related to the case management. Furthermore, LPA also completed a safety inspection of the Center.

Due to the need to gather additional information, this case management requires additional investigation.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative Emily Aguilar.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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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