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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412222
Report Date: 01/29/2021
Date Signed: 01/29/2021 11:35:01 AM

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:CABRERA FAMILY CHILD CAREFACILITY NUMBER:
197412222
ADMINISTRATOR:CABRERA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 965-1080
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 11DATE:
01/29/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:GUADALUPE CABRERATIME COMPLETED:
11:15 AM
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On 1/29/2021 Licensing Program Analyst (LPA) Loyce Phillips conducted a Case Management- Incident inspection to follow up on an Unusual Incident reported to the department by Email on 11/22/2020; this incident was reported timely. LPA spoke with Licensee, Guadalupe Cabrera; Due to COVID-19 Emergency Response this inspection was conducted Tele-Visit. LPA virtually toured the facility and took a census of the children. Upon arrival, there were 11 children and 3 staff present today at the facility.

Description of the incident: On 11/18/2020 child 1 was playing outside when he urinated on himself in a box. Child 1 went to staff 3 and stated, "look I peed." Staff 3 asked why did you do that and child responded, "I don't know" and started smiling and laughing. Later that evening, parent 1 question her child "why did you urinate on yourself?" Child 1 responded "because child 2 touched my private area."

Based on the information obtained, interviews conducted and LPA’s observation there was limited contact between child 1 and child 2 on date of the incident; therefore, no Title 22 violations have occurred and no deficiencies cited. The facility is encouraged to continue to report unusual incidents that occur in the facility. An exit interview was conducted, and a copy of this report was read and provided to the Licensee, Guadalupe Cabrera.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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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