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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750053
Report Date: 10/04/2021
Date Signed: 10/04/2021 04:57:01 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 WORLD CHILD CAREFACILITY NUMBER:
197750053
ADMINISTRATOR:YESENIA CANCHOLAFACILITY TYPE:
850
ADDRESS:44221 10TH ST. WESTTELEPHONE:
(661) 802-4734
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:24CENSUS: 12DATE:
10/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Silvia JavierTIME COMPLETED:
05:10 PM
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Upon arrival LPA Maddox and LPM Bell met with Silvia Javier. Lead Teacher today. LPA and LPM observed 12 children with 1 staff providing care and supervision. During this inspection, Stephanie Roberts was not present.

The California Department of Social Services (CDSS) has determined that Stephanie Roberts continued or future contact with clients or presence in any community care facility, child day care facility, residential care facility for the elderly, or any other facility licensed by CDSS, constitutes a threat to the health, welfare or safety of the clients in care.

Upon receipt of the immediate exclusion order, Stephanie Roberts, must remove herself from any contact with clients and not be physically present in any facility.

The order to Immediately Exclude Stephanie Roberts was discussed in detail with Silvia Javier is aware that Stephanie Roberts must not be physically present in the facility nor can she have contact with children in care.

Silvia Javier acknowledges the receipt of the Immediate Exclusion Order served today.

An exit interview was conducted with Silvia Javier and a copy of this report was provided along with the appeal rights.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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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