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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364811636
Report Date: 10/18/2019
Date Signed: 10/18/2019 03:30:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:SBCSS YUCCA VALLEY STATE PRESCHOOLFACILITY NUMBER:
364811636
ADMINISTRATOR:KYLENE RICKETTSFACILITY TYPE:
850
ADDRESS:7601 HOPI TRAIL, ROOM K-3TELEPHONE:
(760) 365-3381
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:24CENSUS: 0DATE:
10/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:KYLENE RICKETTSTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Aaron Mabika met with Kylene Ricketts, Lead Teacher, for a Case Management Incident inspection involving an Incident Report dated 08/26/2019

Description of the incident: Summary of Incident: CLOSURE DUE TO ONGOING WATER DAMAGE. FACILITY WILL BE CLOSED FROM 8/26/10 THROUGH TBD. RP STATES IT COULD TAKE UP TO ONE WEEK. A tour of the facility was conducted TO NOTE THE EXTEND OF THE damage. The affected part was the entire western wall of the mobile building due to water seepage that occurred in the wall. The dry wall was replaced in its entirety and some of the wall fixtures at the affected wall were removed. Per lead teacher, there is a plan to replace the carpet over the summer. LPA and lead teacher had tour of the remodelling done.

Based on information provided and interviews conducted the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore, no deficiencies were cited.

An exit interview was conducted, and a copy of this report was read and provided to Kylene Ricketts, Lead Teacher, on this date.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Aaron MabikaTELEPHONE: (661) 305-7599
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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