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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408073
Report Date: 04/03/2024
Date Signed: 04/03/2024 02:06:56 PM

Document Has Been Signed on 04/03/2024 02:06 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:LANDERS FAMILY CHILD CAREFACILITY NUMBER:
197408073
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		LANDERS, KARLENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 618-1333
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Karlene LandersTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Carol Heath met with the Licensee Karlene Landers for a case management incident inspection involving an Unusual Incident Report (UIR) received by fax on 4/2/2024. LPA toured the facility and took a census of the children. Upon arrival, there were 3 children with licensee and her licensee’s husband (Assistant) present today.

Description of the incident: An incident occurred on 3/28/2024, PRO Officer of the Day (OD) received a fax from the licensee to report UIR. C1 was swinging on the swing, jumped off, and injured their wrist. The parents took him to urgent care.
LPA reviewed the child#1’s file and received a copy of the Roster.

Based on the 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 the report was read and provided to the licensee, Karlene Landers .
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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