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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808413
Report Date: 07/13/2023
Date Signed: 07/13/2023 12:00:11 PM

Document Has Been Signed on 07/13/2023 12:00 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:SAN BERNARDINO CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364808413
ADMINISTRATOR:LATASHIA KELLYFACILITY TYPE:
830
ADDRESS:2350 N. E STREETTELEPHONE:
(909) 388-6307
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 13DATE:
07/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Facility Representative Annabell Lopez MaganaTIME COMPLETED:
12:15 PM
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On July 13, 2023, at 09:15 a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Case Management Incident inspection and met with facility representative Annabell Lopez Magana. LPA disclosed the purpose of the inspection and was granted entry into the facility by a facility representative. 10 toddlers, three infants and seven staff members were present in the facility during the inspection.

The purpose of the inspection was to follow up on a self-reported unusual incident report (UIR) which occurred on June 28, 2023 at the facility. The Department was notified of the UIR on June 29, 2023. According to the UIR, child 1 (C1), child 2 (C2), and child 3 (C3) were observed in the parking structure which is outside of the enclosed play yard. According to the UIR, the maintenance workers left the gate unlocked after they had been working in the play yard before the toddlers went outside to play. Per UIR, C1, C2, C3 were immediately returned to the play yard and the gates were secured.

During the inspection today, LPA interviewed four staff members and review C1, C2 and C3 files. Per facility representative the Center does not have video evidence of the incident.

LPA completed a safety inspection of the classroom and play yard at 9:25 a.m. Zero deficiencies were observed.

During today's investigation, LPA obtained documents related to the UIR. Further investigation is required in order to resolve the case management.

An exit interview was conducted, a copy of this report, and notice of site visit were provided to the facility representative.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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