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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400197
Report Date: 05/31/2022
Date Signed: 06/01/2022 09:02:53 AM

Document Has Been Signed on 06/01/2022 09:02 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:ROBLES FAMILY DAY CAREFACILITY NUMBER:
197400197
ADMINISTRATOR:ROBLES, AMPAROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 944-4851
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 14TOTAL ENROLLED CHILDREN: 3CENSUS: 0DATE:
05/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Nancy RoblesTIME COMPLETED:
02:34 PM
NARRATIVE
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On 5/31/2022, LPA Carol Heath conducted an unannounced Case Management Deficiency inspection. LPA met with licensee Robles, who granted inspection authority. Also present for the inspection were 0 children in care. The licensee stated there are currently 3 children enrolled. Children’s files were reviewed.
On 5/9/2022, LPA went to conduct an unannounced Annual inspection. When LPA arrived at the facility, the licensee was not home. There were 3 school-age children and a person in the facility. LPA asked where was the licensee. The person said he is the licensee’s grandson. His name is Daniel Rubles Youry. LPA asked Daniel Rubles Youry (Grandson) was the licensee. According to the grandson, the licensee is in the doctor's office. LPA asked what is his name and asked him to write down his name. Pre-Roster, Daniel is not on the list. There were 3 daycare children. Pre Daniel needs to bring those children to school.

LPA Heath was in the car to talk to the LPM. A man came to the car and introduced himself as James Robles (The licensee's son). He said his mother is visiting a family member (her sister) who passed last week. She will not return until next Wednesday. The licensee's daughter Nancy Robles is taking care of the facility. LPA checked the roster. Nancy's fingerprint is still in process. LPA let James knows they can not have any daycare children in the facility. James said he will let his sister know.
See next page
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: ROBLES FAMILY DAY CARE
FACILITY NUMBER: 197400197
VISIT DATE: 05/31/2022
NARRATIVE
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The licensee was informed that she has to maintain documentation of criminal record clearances or criminal record exemptions of employees, volunteers that require fingerprinting and non-client adults residing in facility.
Violation Cited During Today’s visit:
Type A: The facility has adults without criminal record clearances
Type A citation to parents/guardians of all children currently enrolled by the next business day
or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with the licensee's assistant Nancy Robles.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022
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Document Has Been Signed on 06/01/2022 09:02 AM - It Cannot Be Edited


Created By: Carol Heath On 05/31/2022 at 02:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ROBLES FAMILY DAY CARE
FACILITY NUMBER: 197400197

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2022
Section Cited
CCR
102370(d)(1)

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Criminal Record Clearance. All
individuals subject to a criminal record review
as specified in Section 1596.871 prior to
working...btain a California clearance or a
criminal record exemption as required by the
Department.
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The grandson is not tranport the children until he has his fingerprint clearn.
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This requirement is not met as evidence by:
Based on observation and interviews, the
licensee did not ensure a criminal reocrd
clearance was for her granddaughter, which
poses an immediated Health, Safety or
Personal Rights risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022


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