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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750017
Report Date: 01/14/2025
Date Signed: 01/14/2025 02:37:49 PM

Document Has Been Signed on 01/14/2025 02:37 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:CHAMPIONS@RALPH BAKER 21ST CENTURY LEARNING CENTERFACILITY NUMBER:
367750017
ADMINISTRATOR/
DIRECTOR:		VILLALOBOS, VALERIEFACILITY TYPE:
840
ADDRESS:15456 EL EVADO RDTELEPHONE:
(760) 338-9234
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
01/14/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:53 PM
MET WITH:Tiffany AvilaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On January 14, 2025, Licensing Program Analyst (LPA), Calloway conducted an unannounced case management inspection to the above facility. LPA met with the facility representative who granted access. The purpose of the inspection was to follow up on a plan of correction. LPA observed four staff and no children in care during the inspection.

On January 9, 2025, LPA conducted an annual inspection and cited a Type A deficiency for three employees that did not have Criminal Record Clearance, nor were they associated to the facility. There was an immediate civil penalty issued during that inspection.

The POC was not corrected and two of the employees were observed working at the facility that were not associated on the roster during the inspection.

There is a failure to correct penalty assessed during this inspection. See LIC 421FC page attached to this report.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Tiffany Avila, Facility Representative at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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