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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414219
Report Date: 10/28/2021
Date Signed: 10/28/2021 09:59:15 PM

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: 6DATE:
10/28/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
07:30 PM
MET WITH:Gwendolyn Joyce Roberts TIME COMPLETED:
10:16 PM
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On October 28, 2021 a Case Management Legal/Non- Compliance Inspection was conducted by Licensing Program Managers (LPMs) Mariela Ramon and Carissa Bell and Licensing Program Analyst (LPA) Lady King-Lewis for the purpose of serving a Temporary Suspension Order (TSO) to the Licensee Gwendolyn Joyce Roberts. Upon arrival, there were 4 school age children and 2 infants during this inspection..

The Licensee Gwendolyn Joyce Roberts was served with the following documents during today’s inspection:

1. Temporary Suspension Order (TSO)


2. Statement to Respondent
3. Government Code Statutes
4. Summary of Instructions for Licensee
5. Summary of Charges
6. Accusation
7. Request for Discovery
8. Notice of Defense
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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
VISIT DATE: 10/28/2021
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The licensee was advised that she must inform all parents concerning the TSO by providing parents with 14 Parent Packets that were provided to the Licensee during the inspection Licensee was advised that she has fifteen (15) calendar days to respond to the TSO by mailing the Notice of Defense included in the TSO Packet. The Notice of the TSO was posted, and the licensee was advised not to remove the sign pending the outcome of the Administrative Action. Licensee was advised that removal of the sign and/or continued operation after today’s date may result in assessment of civil penalties.

An exit interview was conducted, and a copy of this report was provided to the licensee

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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