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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750082
Report Date: 05/04/2021
Date Signed: 05/04/2021 05:00:22 PM

Document Has Been Signed on 05/04/2021 05:00 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:TINKER VILLAGEFACILITY NUMBER:
197750082
ADMINISTRATOR:ERICKA DIAZFACILITY TYPE:
850
ADDRESS:41955 50TH STREET WEST #103TELEPHONE:
(661) 718-3081
CITY:QUARTZ HILLSSTATE: CAZIP CODE:
93536
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
05/04/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Erica DiazTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Maddox and Licensing Program Manager, Carissa Bell met with Licensee, Erica Diaz today to conduct an Pre-licensing inspection for proposed School age program. During that inspection, LPA noticed there were 4 School age children present at the center and there is no licensed School age program at this time. A citation will be issued today for limitation of capacity. LPM Bell explained to licensee there can not be School age children present unless there is an approved School age license.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2021
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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Document Has Been Signed on 05/04/2021 05:00 PM - It Cannot Be Edited


Created By: Donna Maddox On 05/04/2021 at 03:29 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: TINKER VILLAGE
FACILITY NUMBER: 197750082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/05/2021
Section Cited
CCR
101161

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(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. While conducting a Pre-licensing inspection for a proposed
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During this inspection licensee stated that School age children will be kept at her licensed FCCH (197415024) starting 5/5/2021. Licensee was informed of her appeal rights
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School age program, LPA and LPM noticed 4 School age children present and there is no license for a SA component.
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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:Mariela Ramon
LICENSING EVALUATOR NAME:Donna Maddox
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2021


LIC809 (FAS) - (06/04)
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