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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844266
Report Date: 08/23/2022
Date Signed: 08/24/2022 04:31:20 PM

Document Has Been Signed on 08/24/2022 04:31 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:READY SET GROW LEARNING SERVICESFACILITY NUMBER:
364844266
ADMINISTRATOR:LILAMANIE SENEWIRATNEFACILITY TYPE:
850
ADDRESS:1528 PUMALO STREETTELEPHONE:
(909) 883-6628
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 35DATE:
08/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Facility Representative Angie BustillosTIME COMPLETED:
02:00 PM
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On August 23, 2022 at 12:01pm Licensing Program Analyst (LPA) Zirbes met with facility representative Angie Bustillos. The purpose of the inspection was to conduct an unannounced case management inspection to the licensed facility. LPA disclosed the purpose of the inspection to facility representative. Present during today’s inspection were 35 preschool age children and five staff members. A safety inspection was completed and zero deficiencies were observed.

The incident was self reported to the Department on August 19, 2022. The incident involved Child 1 (C1) receiving an injury to the face on August 18, 2022. During the case management inspection LPA completed confidential interviews with six children and two staff members. In addition, LPA obtained documentation related to the incident.

Further investigation is required in regards to the incident.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Office Assistant Angie Bustillos.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: READY SET GROW LEARNING SERVICES
FACILITY NUMBER: 364844266
VISIT DATE: 08/23/2022
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SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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