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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197750104
Report Date: 09/22/2021
Date Signed: 09/22/2021 04:20:35 PM

Document Has Been Signed on 09/22/2021 04:20 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:SMALL WONDERS DAY CARE & PRESCHOOL INC.FACILITY NUMBER:
197750104
ADMINISTRATOR:VERONICA ROSEFACILITY TYPE:
850
ADDRESS:42537 50TH STREET WESTTELEPHONE:
(661) 816-8563
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 65TOTAL ENROLLED CHILDREN: 0CENSUS: 16DATE:
09/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Administrator Veronica Rose TIME COMPLETED:
04:25 PM
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On September 22, 2021 at 3:20pm Licensing Program Analyst (LPA) Kendal Zirbes met with Administrator Veronica Rose to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self-reported unusual incident report submitted on September 10, 2021. The unusual incident report was regarding a personal rights incident involving staff 1 (S1) and child 1 (C1). (Refer to confidential name list, LIC 811 dated 9/22/2021). Upon arrival, there were 16 children and 5 staff present today at the facility.

During this inspection LPA conducted one staff interview and one confidential interview. LPA also completed a safety inspection at approximately 3:40pm. At this time there were no deficiencies noted. In addition during the inspection, LPA obtained documentation related to the case management incident. Additional documentation was requested and will be provided to LPA by 10:00am on September 23, 2021.

Due to the need to gather additional information, this investigation is being extended.

Licensee’s signature on this form acknowledges receipt of this document.


Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Copies of this report must be posted for 30 days in location visible to the authorized representatives of children.

An exit interview was conducted, and appeal rights were provided to Administrator Veronica Rose. A copy of this report and notice of site inspection were provided and explained during this inspection.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2021
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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