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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750034
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:44:47 PM

Document Has Been Signed on 08/17/2023 12:44 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KIDS & CARE INC.FACILITY NUMBER:
367750034
ADMINISTRATOR:CLAUDIA V. GARCIAFACILITY TYPE:
850
ADDRESS:15138 MAIN ST.TELEPHONE:
(760) 956-5000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
08/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Sonia Galvaz, Site SupervisorTIME COMPLETED:
12:45 PM
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On August 17, 2023, Licensing Program Analyst (LPA), Kuliema Calloway made an unannounced Case Management inspection visit to the Kids and Care Inc. LPA met with S1 who granted access.

The purpose of the inspection was to notify S1, that based on record reviews, on 06/13/23, a day care child slapped another day care child in the face. On 6/14/23, a daycare child bit another daycare child and left a bite mark on the left side of the child’s back. On 06/15/2023, a daycare child showed their private parts to another daycare child. On 7/12/23, a daycare child bit another daycare child on their right arm and left teeth marks. On 7/13/23, a daycare child bit another daycare child and left bite marks on the child’s back. The facility did not report the unusual incidents mentioned above to Community Care Licensing Division.

Per Title 22 Regulations, Division 12, Chapter 1, There was one (1) Type B deficiency cited for 101212(d)(1)(C) Reporting Requirements.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeals Rights were discussed and provided to Sonia Galvaz, Site Supervisor, at the facility.

Failure to maintain the Notice of Site Visit for thirty (30) consecutive days, will result in a $100 Civil Penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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 08/17/2023 12:44 PM - It Cannot Be Edited


Created By: Kuliema Calloway On 08/17/2023 at 11:55 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: 367750034

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2023
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C)Reporting Requirements: Upon the occurrence, during operation of childcare center of any...events specified in (d)(1) below, a report...(1) Events reported… shall include…(C) Any unusual incident … This requirement was not met as evidenced by:
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Per Site Supervisor stated they will be sure to call in incidents immediately and file necessary paperwork within 24 hours. Site Supervisor stated they will provide a written declaration to Licensing by chosen POC date of 8/18/2023.
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Based on interviews and record reviews, there were injuries and inappropriate behavior that was not reported to Licensing which posed a potential health, safety, or personal rights risk to the 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:Claretta Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


LIC809 (FAS) - (06/04)
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