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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841958
Report Date: 04/21/2023
Date Signed: 04/21/2023 04:42:24 PM

Document Has Been Signed on 04/21/2023 04:42 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:MARQUEZ FAMILY CHILD CAREFACILITY NUMBER:
364841958
ADMINISTRATOR:MARQUEZ, HEIDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 713-5144
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Heidi MarquezTIME COMPLETED:
02:05 PM
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On April 21, 2023 at 11:40 AM, Licensing Program Analyst (LPA) Beneroso arrived at the facility for the purpose to conduct a case management incident inspection to follow-up on an unusual incident that occurred on or about February 2023 and was reported to the Department on 2/6/23. Upon arrival, LPA  was greeted by Rosalyn Flores, assistant. The licensee, Ms. Marquez arrived shortly after.

The Unusual Incident Report indicated that on or about February 2023 child #1 had inappropriate contact with child #2. The follow up investigation conducted by Investigator Ryan Miles and LPA Beneroso consisted of interviews with staff, children, and the review of pertaining documents related to the investigation. During the follow up investigation conducted by Investigator Ryan Miles and interviews conducted by LPA Beneroso, it was concluded that there were inconsistencies concerning the inappropriate contact between child  #1 and Child #2.
The licensee took the appropriate actions by reporting the incident to the regional office.

*Report Continues on LIC809-C
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MARQUEZ FAMILY CHILD CARE
FACILITY NUMBER: 364841958
VISIT DATE: 04/21/2023
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The information obtained during the unusual incident follow up investigation revealed no violations were found. Facility is encouraged to continue to report incidents that occur in the facility.
 
An exit interview was conducted, and a copy of the report was provided to Licensee, Mrs. Marquez.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Barbara Beneroso
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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