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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813684
Report Date: 08/18/2021
Date Signed: 08/18/2021 02:34:41 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:KIDCARE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364813684
ADMINISTRATOR:CARMEN RODRIGUEZFACILITY TYPE:
840
ADDRESS:15025 GRAVILLA ROADTELEPHONE:
(760) 955-6466
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: DATE:
08/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Carmen RodriguezTIME COMPLETED:
02:49 PM
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On 08/18/21, Licensing Program Analyst (LPA) Justin Dorsey conducted an initial 10 day inspection for the complaint posed against the pre-school component (#364813683). LPA disclosed the purpose of the inspection and was granted entry by Licensee, Carmen Rodriguez who guided LPA on a tour of the facility.

While conducting the investigation it was found that Child #1 was being transitioned from the preschool to the school age program when an injury occurred. Per Director Child #1 was with the school-age program on the school-age playground when an injury occurred. While inspecting the playground LPA Dorsey observed the slide was broken. LPA Dorsey observed a metal piece hanging along from the right side of the slide. Through interview with the Director LPA Dorsey found that the facility is in the process of getting a new slide. The Director states children have not used the slide for a "couple of weeks". LPA Dorsey also interviewed Child #2, they stated that they have not used the slide "in a vey long time" because it is broken. Child #1 also stated that no one else uses the slide at that their teachers tell them not to use the slide.

During the visit the piece of metal was removed from the slide. LPA Dorsey observed the Director placed chairs and streamers around the structure as a reminder to children that the structure is off limits. Per Director she plans on getting someone to screw the metal piece back on the slide tonight (08/18/21)

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 posted for 30 days.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit was provided Director Rodriguez.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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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