<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840609
Report Date: 06/08/2022
Date Signed: 06/08/2022 02:34:59 PM


Document Has Been Signed on 06/08/2022 02:34 PM - It Cannot Be Edited

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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
364840609
ADMINISTRATOR:RODRIGUEZ, KRISHNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 220-7468
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:14CENSUS: 14DATE:
06/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Krishna RodriguezTIME COMPLETED:
02:34 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Thompson-Miller met with Krishna Rodriguez, for a Case Management Incident inspection involving an Incident Report dated May 26, 2022. The incident occurred on May 26, 2022. There are 9 preschool children and two infants along with two assistants and Licensee. Upon arrival children were already laid down for nap time. During the inspection 3 additional children (school age) arrived, total now 14 children.

Description of the incident: Child allege Staff #1 grabbed her arm while on her chair eating lunch and spanked her for not eating.
The focus of the inspection is to obtain a copy of the Roster and conduct interviews with staff.

Based on information provided and interviews conducted the incident needs further investigation. Declarations were provided from staff.

A copy of this report was given to Krishna Rodriguez. An exit interview was conducted and a copy of this report was read and provided to Krishna Rodriguez on this date.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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 1