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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814430
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:02:18 PM

Document Has Been Signed on 04/19/2023 02:02 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:PSD YUCCA VALLEY HEAD STARTFACILITY NUMBER:
364814430
ADMINISTRATOR:LUGENE SPRINGFIELDFACILITY TYPE:
850
ADDRESS:56389 PIMA TRAILTELEPHONE:
(760) 369-7424
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 16DATE:
04/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Facility Representative Edna Day TIME COMPLETED:
02:10 PM
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On April 19, 2023 at 01:30 p.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Case Management - Other inspection and met with Facility Representative Edna Day. LPA disclosed the purpose of the inspection and was granted entry into the facility by facility representative. 16 children, and five (5) staff members were present at the facility during the inspection.

At approximately 1:40 p.m. LPA and Facility representative conducted a safety inspection of the Center. No deficiencies were observed.

During the inspection, LPA completed a interview with facility representative Edna Day and received documentation related a self reported incident.

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


SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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