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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414219
Report Date: 10/26/2021
Date Signed: 10/27/2021 07:20:18 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:ROBERTS FAMILY CHILD CAREFACILITY NUMBER:
197414219
ADMINISTRATOR:ROBERTS, GWENDOLYN J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 400-9912
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:14CENSUS: DATE:
10/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:14 PM
MET WITH:Gwendolyn Joyce RobertsTIME COMPLETED:
05:15 PM
NARRATIVE
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On October 26, 2021, Licensing Program Analyst (LPA) Lady King-Lewis and Licensing Program Manager (LPM), Mariela Ramon, conducted a case mamagement inspection at the above facility. . Upon arrival, LPA and LPM met with licensee daughter Camille Mcghee staff #1 who was providing care to 8 children, and 1 infant with the assistance of 3 staff members.

LPA and LPM observed infant #1 lying in a play pen with a boppy (pillow) and blanket. LPA informed staff #1 that infant sleeping area should not have any items in the play pen except a firm mattress. Although the infant was not sleep at the time of the inspection the child was lying on back with infant head proprted up on a bobi (pillow) and blank.

A Type B deficiency will be cited under Title 22 Regulation code 102425(b) under Infant safe sleep.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: ROBERTS FAMILY CHILD CARE
FACILITY NUMBER: 197414219
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/02/2021
Section Cited

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Infant Safe Sleep
Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as as evidence by.: Based on LPA and LPM observations LPA and LPM observed infant #1 lying in a playbin with a bobi (pollw) and blanket This poses a potintial risk health and safety risk to 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: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2021
LIC809 (FAS) - (06/04)
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