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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843655
Report Date: 08/17/2023
Date Signed: 08/17/2023 10:43:40 AM

Document Has Been Signed on 08/17/2023 10:43 AM - 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 & CARE PRESCHOOL & CHILD CARE CENTERFACILITY NUMBER:
364843655
ADMINISTRATOR:LUZ MARISOL VALENZUELAFACILITY TYPE:
830
ADDRESS:10662 MAPLE AVENUETELEPHONE:
(760) 956-2000
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 8DATE:
08/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Luz Marisol Valenzuela, Site DirectorTIME COMPLETED:
10:45 AM
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On August 17, 2023, Licensing Program Analyst (LPA), Kuliema Calloway made an unannounced Case Management inspection visit to the Kids and Care Preschool and Child Care Center. LPA met with S1 who granted access. LPA observed 9 infants and 3 staff in care.

LPA discussed with S1, the building air conditioning unit that was inoperable for at least two weeks, should have been reported as an unusual incident to Community Care Licensing Division. This a Type B deficiency as it poses a potential health, safety, and personal rights risks to the persons in care.

Per Title 22 Regulations, Division 12, Chapter 1, There was one (1) Type B deficiency cited for 101212(d)(1)(C) Reporting Requirements.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeals Rights were discussed and provided to Luz Marisol Valenzuela, Site Supervisor, at the facility.

Failure to maintain the Notice of Site Visit for thirty (30) consecutive days, will result in a $100 Civil Penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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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Document Has Been Signed on 08/17/2023 10:43 AM - It Cannot Be Edited


Created By: Kuliema Calloway On 08/17/2023 at 10:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KIDS & CARE PRESCHOOL & CHILD CARE CENTER
FACILITY NUMBER: 364843655

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements. Upon...occurrence, during operation of childcare center any events...(d)(1) below, a report shall be made … (d)(2) below shall… (1) Events reported… shall... (C) Any unusual incident … This requirement was not met as evidenced by:
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Per Site Director, unusuual incidents in the future will be reported to Licensing. A written declaration will be provided by POC date 8/24/23 to Licensing stating reporting of unusual incidents will occur in the future.
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Based on interviews and observation, the building AC unit was inoperable for at least two weeks, and it was not reported to Licensing which posed a potential 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 Yates
LICENSING EVALUATOR NAME:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


LIC809 (FAS) - (06/04)
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