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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700179
Report Date: 06/24/2024
Date Signed: 06/24/2024 10:52:50 AM

Document Has Been Signed on 06/24/2024 10:52 AM - 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:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
367700179
ADMINISTRATOR/
DIRECTOR:		JACKIE WILLIAMSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 531-6006
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
06/24/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Licensee Jackie Williams TIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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On June 24, 2024 at 09:05a.m., Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Plan of Correction (POC) inspection and met with Licensee Jackie Williams. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee. Seven children were present (two school age and five preschool age children) and the Licensee.

During this inspection, LPA observed the Licensee providing supervision. S1 was not observed by LPA. Licensee confirmed S1 was not on the property and stated S1 has not provided supervision since the inspection on June 13, 2024.

Based on LPA observed and information obtained from the Licensee, the citation issued June 13, 2024 has been corrected.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Jackie Williams.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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