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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750031
Report Date: 09/26/2023
Date Signed: 10/03/2023 02:17:42 PM

Document Has Been Signed on 10/03/2023 02:17 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 INC.FACILITY NUMBER:
367750031
ADMINISTRATOR:CLAUDIA V. GARCIAFACILITY TYPE:
850
ADDRESS:10522 MANHASSET ROADTELEPHONE:
(760) 956-5000
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 33DATE:
09/26/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:16 PM
MET WITH:Patricia Jacobs, Director TIME COMPLETED:
03:30 PM
NARRATIVE
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On 10/03/23, This report is being amended to cite a Type A citation for failure to follow the Fire Clearance granted by the State Fire Marshal, Fire Clearance 101171(a). Please see amended deficiency page 809-D for updated information.

On 09/26/23, Licensing Program Analyst (LPA) Justeene Tamayo met with Director Patricia Jacob's, for the purpose to conduct a Case Management visit-Plan of Correction for the Type A deficiency that was cited on 09/22/23. Upon arrival LPA observed 33 preschool in care with 2 Teachers. The Center also Licensed for a Infant component (X367750029) and a School age component (X367750030) on the same premises.

The purpose of the visit is to conduct a Plan Of Correction Visit to ensure the center meets State Licensing Title 22 Regulations: Limitation on Capacity Section 101161(a).

A tour of the facility was conducted along with the Director, LPA Observed the facility is operating beyond the limitation specified on the Facility License and did not meet the Title 22 Regulations :Limitation on Capacity. A Civil Penalty Assessment $200 for Failure to Correct. See LIC 421FC

An exit interview was conducted, and a copy of this report was read and provided to Director Patricia Jacob's, along with a Notice of Site Visit and appeal rights.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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 10/03/2023 02:17 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 10/03/2023 12:40 PM


Created By: Justeene Tamayo On 09/26/2023 at 02:17 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KIDS & CARE INC.
FACILITY NUMBER: 367750031

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/26/2023
Section Cited
CCR
101161(a)

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Limitations on Capacity and Ambulatory Status 101161(a): A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
This requirement was not met as evidence by:
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Director shall sign a declaration stating she will abide by the maximum capacity of 12 preschool children.
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LPA observed 33 preschool children on the premises with a limited capacity of 12 preschool children, which poses an immediate health and safety risk to children in care.
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Type A
10/26/2023
Section Cited
CCR101171(a)

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Fire Clearance 101171(a): All child care centers shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.
This requirement was not met as evidence: by:
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Licensee shall ensure she is following the fire clearance granted by the State Fire Marshal.
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LPA observed 33 preschool children, which does not follow the fire clearance granted by the State Fire Marshal, which poses an immediate health and safety risk to children 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:Mariela Ramon
LICENSING EVALUATOR NAME:Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023


LIC809 (FAS) - (06/04)
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