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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750052
Report Date: 05/24/2021
Date Signed: 05/24/2021 02:27:11 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:IT'S A SMALL WORLDFACILITY NUMBER:
197750052
ADMINISTRATOR:CANCHOLA, ANTONIO&YESENIAFACILITY TYPE:
830
ADDRESS:44221 10TH ST WESTTELEPHONE:
(661) 492-0550
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:39CENSUS: 15DATE:
05/24/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Licensee Yesenia CancholaTIME COMPLETED:
02:45 PM
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On May 24, 2021 at 10:16 AM, Licensing Program Analyst (LPA) Tsutaoka conducted an initial inspection for the complaint posed against the facility dated 05/19/21. LPA disclosed the purpose of the inspection and was granted entry by Licensee, Yesenia Canchola who guided LPA on a tour of the facility. Upon entry, LPA counted 15 children in care with 4 staff. LPA obtained names of Staff 1, Staff 2, Staff 3, and Staff 4 during walk through and determined Staff 1 and Staff 2 are not on association list.

At 10:30AM, LPA and Licensee conducted discussion and reviewed staff files together. After file review, it was determined no documentation associating or clearing Staff 1 and Staff 2 was in the facility files. During inspection, Licensee stated Staff 1 is fingerprint cleared and provided fingerprint transfer request to LPA. According to Licensee, Staff 2 completed fingerprint clearance 5/13/21, but is not yet on association list. During inspection, LPA verified Staff 1 is eligible-cleared in Guardian, but not on association list to facility.

California Code of Regulations, Title 22, Division 12 Chapter 1, 101170(e)(2) Criminal Record Clearance Type A violation and 101170(e)(1) Type A violation is being cited on attached LIC809D.

A Civil Penalty of $1000 has been assessed during this inspection for staff criminal record clearance. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. A copy of this licensing report (LIC809) must also be
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
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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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: IT'S A SMALL WORLD
FACILITY NUMBER: 197750052
VISIT DATE: 05/24/2021
NARRATIVE
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posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Copies of the reports must also be provided to each parent. A copy of the Acknowledgment of receipt of licensing report (LIC9224) was
provided and must be kept in each child's file. In addition, any child enrolled within the following 12 months must also receive a copy of the Type A Citation.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided to Licensee.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: IT'S A SMALL WORLD
FACILITY NUMBER: 197750052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/25/2021
Section Cited

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101170 Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working... (2)Request a transfer of a criminal record clearance. This requirement was not as evidence by:
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Based on observation and record review: Licensee did not ensure Staff 1 completed the criminal record transfer request prior to working at the facility which poses an immediate Health and Safety Risk to children in care.
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Type A
05/25/2021
Section Cited

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101170 Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working... (1)Obtain a California clearance. This requirement was not as evidence by:
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Based on observation and record review, Licensee did not ensure Staff 2 was fingerprint cleared prior to working at the facility which poses an immediated 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: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Brigitte TsutaokaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2021
LIC809 (FAS) - (06/04)
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