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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750010
Report Date: 12/07/2021
Date Signed: 12/07/2021 02:45:12 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:ADVENTUROUS LEARNING GROUP, INCFACILITY NUMBER:
367750010
ADMINISTRATOR:ERIKA, SALTZMANFACILITY TYPE:
840
ADDRESS:15011 BEAR VALLEYTELEPHONE:
(760) 948-5500
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:10CENSUS: 0DATE:
12/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kymberli WrightTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with Kymberli Wright, Assistant Director for the purpose of a Case Management Incident inspection involving an Incident Report dated 09/10/19. The incident occurred on September 9, 2019.

Description of the incident: Child #1 was inappropriately touched with a marker by Child #2. Child #1 and Child #2 were in route to the center when the two children engaged in inappropriate activity. Based on interviews with staff, parents and Child #1, the children were on the van and both played doctor. Child #2 did not provide statement to LPA. Staff was present on the van (Driver).

Based on the interviews conducted and insufficient evidence, the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore, no deficiencies were cited. Exit interview conducted, a copy of report was read and provided to Kymberli Wright, Assistant Director on this date.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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