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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364819502
Report Date: 05/11/2023
Date Signed: 05/11/2023 02:38:30 PM


Document Has Been Signed on 05/11/2023 02:38 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:KIDS AND CARE PRESCHOOL AND DAY CARE CENTERFACILITY NUMBER:
364819502
ADMINISTRATOR:CLAUDIA VALENZUELA GARCIAFACILITY TYPE:
850
ADDRESS:9560 I AVETELEPHONE:
(760) 956-5000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:60CENSUS: 56DATE:
05/11/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Nancy Sandoval, TeacherTIME COMPLETED:
02:30 PM
NARRATIVE
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On May 11, 2023, Licensing Program Analyst (LPA) Kuliema Calloway made an unannounced inspection to the Kids and Care Pre School and Day Care Center. The purpose of the visit was to conduct a case management inspection. LPA met with S1 who granted access. LPA observed 56 napping children and 14 staff. S2 and S3 arrived to the facility later.

IB Investigator Wilfredo Vasquez investigated a self reported Unusual Incident Report for an incident that occurred on 12/28/2022, resulting in a child sustaining an injury while in care. C1 was pushed by C2 and C2 fell on top of C1 resulting in injury. Staff was not in a clear line of site to observe the fall and staff did not attend to C1’s injury after being told the arm was hurt, by C1.

Based on interviews, record reviews, and other relevant evidence determined that the child was injured at the facility due to Neglect/ Lack of Supervision. This is a Type A deficiency that resulted in an injury to a child while in care. An immediate $500.00 civil penalty will be assessed.

Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Continued on 809 C.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KIDS AND CARE PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 364819502
VISIT DATE: 05/11/2023
NARRATIVE
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LPA Calloway informed the site Director to provide a copy of this licensing report dated 5/11/2023 with the Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted and a copy of this report, Notice of Site Visit, and Appeals Rights were discussed and provided to S3. A Notice of Site visit was posted and must remain posted for 30 days. Removal of posting is subject to a $100 civil penalty.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/11/2023 02:38 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551


FACILITY NAME: KIDS AND CARE PRESCHOOL AND DAY CARE CENTER
FACILITY NUMBER: 364819502

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/12/2023
Section Cited
CCR
101229(a)(1)

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101229(a)(1) (a)The licensee shall provide care/ supervision as necessary to meet the children's needs.(1)No child... left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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Provide training to staff and send proof of the completed training with a staff sign in sheet to the Department no later than 5/12/2023.
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Based on Interviews, record reviews, relevelant evidence determined that the child was injured at the facility due to Neglect/ Lack of Supervision. Which poses an immediate health, safety, or personal rights risk to the children in care.
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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 YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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