<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750014
Report Date: 10/09/2024
Date Signed: 10/09/2024 11:07:21 AM

Document Has Been Signed on 10/09/2024 11:07 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:JUST 4 KIDSFACILITY NUMBER:
367750014
ADMINISTRATOR/
DIRECTOR:		MORRIS, JENNIFERFACILITY TYPE:
840
ADDRESS:15420 RANCHERO ROADTELEPHONE:
(760) 244-8280
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 18DATE:
10/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Breesa InmanTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Carol Heath conducted a case management incident inspection with VP of Operation, Breesa Inman regarding a Unusual Incident Report (UIR) received by phone on 10/02/2024. During the visit, LPA toured the facility and conducted a headcount of the children. At the time of arrival, 18 school age children were present, along with 2 teachers, the VP, and the assistant director.

Incident Description:
On 09/27/2024, the Director contacted the PRO Officer of the Day (OD) to report a UIR. The incident involved Child #1, playing catch with a group of children. While attempting to get the football, Child #1 and another child began pushing each other. Child #1 lost footing and braced the fall with the left arm.

After reviewing the information and conducting interviews with Breesa who observed the incident, it was determined the incident was not the result of any violation of Title 22 regulations, and no deficiencies were cited at this time.

An exit interview was conducted, and a copy of the report was reviewed and provided to VP of Operations Breesa Inman.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1