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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
364843943
Report Date:
11/01/2019
Date Signed:
11/01/2019 05:20:08 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:
ROSITA R. SMITH H.Q. PRESCHOOL, INC.
FACILITY NUMBER:
364843943
ADMINISTRATOR:
ROSITA R. SMITH
FACILITY TYPE:
830
ADDRESS:
1455 E. LYNWOOD DRIVE
TELEPHONE:
9098048808
CITY:
SAN BERNARDINO
STATE:
CA
ZIP CODE:
92404
CAPACITY:
18
CENSUS:
0
DATE:
11/01/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:50 PM
MET WITH:
Rosita Smith
TIME COMPLETED:
05:20 PM
NARRATIVE
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LPA Aaron Mabika met with Director Rosita R Smith for the sake of correcting the
COMPLAINT CONTROL NUMBER:
12-CC-20191004174207
by issuing the LIC809D document as per requirement. At this time no children were available as they had been picked up
SUPERVISOR'S NAME:
Claretta Yates
TELEPHONE:
(661) 789-6944
LICENSING EVALUATOR NAME:
Aaron Mabika
TELEPHONE:
(661) 305-7599
LICENSING EVALUATOR SIGNATURE:
DATE:
11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/01/2019
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
2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
1605 EAST PALMDALE BLV, STE A
PALMDALE
,
CA
93550
FACILITY NAME:
ROSITA R. SMITH H.Q. PRESCHOOL, INC.
FACILITY NUMBER:
364843943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/17/2019
Section Cited
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(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the licence, including the capacity limitation.
this poses ban immediate risk to the health and safety of children in care
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A declaration is to be submitted no later than the plan of correction due date and an application for a waiver is to be sent in to the department.
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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:
Claretta Yates
TELEPHONE:
(661) 789-6944
LICENSING EVALUATOR NAME:
Aaron Mabika
TELEPHONE:
(661) 305-7599
LICENSING EVALUATOR SIGNATURE:
DATE:
11/01/2019
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/01/2019
LIC809
(FAS) - (06/04)
Page:
2
of
2