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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843656
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:42:45 PM

Document Has Been Signed on 10/27/2022 01:42 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KIDS & CARE PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
364843656
ADMINISTRATOR:LUZ MARISOL VALENZUELAFACILITY TYPE:
850
ADDRESS:10662 MAPLE AVENUETELEPHONE:
(760) 956-2000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 23DATE:
10/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Luz ValenzuelaTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carol Heath met with Director Luz Valenzuela and Assistant Director Alyse Sanders for a Case Management – Deficiencies inspection involving an Incident dated 10/18/2022.
Description of the incident: On 10/18/2022, Palmdale Regional Office received a complaint from the anonymous person to report a daycare child sustained a fracture due to lack of supervision during class hours. LPA reviewed FAS and the daycare did not call the RP on 10/18/2022 or submit LIC 624.

Based on the information gathered and interviews, the daycare did not follow Title 22 102316.2 (a) Reporting Requirements.

Therefore, Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and/or Health & Safety codes.

An exit interview was conducted, and a copy of the report was read and provided to the Director Luz Valenzuela and Assistant Director.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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Document Has Been Signed on 10/27/2022 01:42 PM - It Cannot Be Edited


Created By: Carol Heath On 10/27/2022 at 01:08 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: KIDS & CARE PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 364843656

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/28/2022
Section Cited
CCR
101212(d)

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Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. ...shall be submitted to the Department
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The director will talk to her staff to report any incident. The director will report any incident to the department in the same day and fill out UIR in 7 days.
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his requirement is not meet as evidenced by:
Based on observation, interview and record review, the licensee did not report to the Palmdale office in the same business day.

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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: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


LIC809 (FAS) - (06/04)
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