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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750032
Report Date: 05/03/2023
Date Signed: 05/03/2023 10:36:50 AM

Document Has Been Signed on 05/03/2023 10:36 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KIDS & CARE INC.FACILITY NUMBER:
367750032
ADMINISTRATOR:CLAUDIA V. GARCIAFACILITY TYPE:
830
ADDRESS:15138 MAIN STTELEPHONE:
(760) 956-5000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
05/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Claudia Garcia, OwnerTIME COMPLETED:
11:00 AM
NARRATIVE
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On May 3, 2023, Licensing Program Analyst (LPA), Kuliema Calloway made an unannounced case management inspection to the above facility. LPA met with S2 who granted access. The purpose of the inspection was to inform the licensee that the documented infant sleep log provided to the LPA on 2/14/2023, does not indicate the time of each fifteen-minute check(s) being conducted for the sleeping infant on 2/13/23 and 2/14/23, as a responsibility for providing care and supervision for infants.

There was one Type B deficiency issued during this visit. Per Title 22, Division 6, Chapter 1, 101429 (C ). See 809 D for deficiency.

Exit interview was conducted and a copy of this report, Notice of Site Visit, and Appeals Rights were discussed and provided to the licensee.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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 05/03/2023 10:36 AM - It Cannot Be Edited


Created By: Kuliema Calloway On 05/03/2023 at 10:08 AM
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 INC.
FACILITY NUMBER: 367750032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
101429(a)(2)(C)

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101429(a)(2)(C) Responsibility for Providing Care & Supervision of Infants
In addition to Section 101229 ...Sleeping infant(s)... observed...at all times. Documentation... maintained... shall include..Time...each 15-minute check... This requiment...not met... evidenced by:

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Provide an infant log that indicates date, infant’s name, time of each 15-minute check, and initials of staff person who conducted each check to the Department no later than due date of 5/12/23.
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Based on record review the center did not comply with the section cited above. The safe sleep log provided for review did not provide the time staff conducted each fifteen-minute, infant safe sleep check which poses a potential health, safety, or personal rights risk to the persons 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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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