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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750035
Report Date: 10/07/2021
Date Signed: 10/07/2021 11:03:58 AM

Document Has Been Signed on 10/07/2021 11:03 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:CHILDREN'S COURTYARD, INC., THEFACILITY NUMBER:
367750035
ADMINISTRATOR:JENNIFER ROSAFACILITY TYPE:
830
ADDRESS:12303 RIDGECREST RD #7477TELEPHONE:
(760) 245-8680
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
10/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:JENNIFER ROSATIME COMPLETED:
11:10 AM
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On 10/07/2021 Licensing Program Analyst (LPA) Carol Heath and LPA Babatunde Ibitoye
conducted a Case management incident inspection to follow up on an Unusual Incident
reported to the department on 10/01/2021. LPA’s spoke with Director Jennifer Rosa, A tour of the facility was conducted.
Description of the incident: On 09/27/2021 at about 8:40AM Child #2 was dropped off by
her mom. She seemed to be in good mood and went to the toy area to play. While teacher
Rosemarie Carrizosa was signing Child #2 in, she felt Child #1 climbing on her leg. She
then heard Child #1 cry and saw a bite mark on his left eye, and she saw Child #2 running
away. The purpose of the inspection is to conduct interview with staff that witnesses the
incident. Present during the time of this inspection and providing care is , 3 Teachers with
the 3 children.
The copy of facility roster for the incident day was collected,
Further investigation is needed, An exit interview was conducted, and a copy of this report was read and provided to Director Jennifer Rosa along with Notice of Site Visit.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
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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