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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750031
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:52:02 PM

Document Has Been Signed on 02/05/2025 01:52 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KIDS & CARE INC.FACILITY NUMBER:
367750031
ADMINISTRATOR/
DIRECTOR:		PATRICIA JACOBSFACILITY TYPE:
850
ADDRESS:10522 MANHASSET ROADTELEPHONE:
(760) 956-5000
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Patricia Jacobs; DirectorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On Wednesday, February 5, 2025, Licensing Program Analysts (LPAs) Cha and Braddock met with facility representatives, Patricia Jacobs and Claudia Garcia who granted access to the facility. The purpose of the inspection was to conduct an unannounced case management inspection for an Unusual Incident Report (UIR) received at Palmdale Regional Office on 02/04/25. LPAs disclosed the purpose of the inspection to the facility representative. When LPAs arrived at the facility there were 10 children in care with 5 staff. The hours of operation for the program is Monday through Friday from 6:00am to 6:30pm.

During the inspection LPAs obtained a roster of children present on the day of the incident. LPAs interviewed staff who were present.

LPAs completed a safety inspection of the facility at approximately 9:45 am.

Based on LPAs observations, further investigation is needed.

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 was conducted and the report was reviewed with the facility representative.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Hanna Cha
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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