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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750030
Report Date: 07/25/2022
Date Signed: 07/25/2022 01:59:42 PM

Document Has Been Signed on 07/25/2022 01:59 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:KIDS & CARE INC.FACILITY NUMBER:
367750030
ADMINISTRATOR:CLAUDIA V. GARCIAFACILITY TYPE:
840
ADDRESS:10522 MANHASSET ROADTELEPHONE:
(760) 956-5000
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 16DATE:
07/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Patricia Jacob'sTIME COMPLETED:
02:20 PM
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On July 25, 2022 Licensing Program Analyst (LPA) Babatunde Ibitoye met with Director Patricia Jacob’s to conduct an unannounced case management inspection. The purpose of the case management was to follow up on a self reported unusual incident report (UIR) submitted to the Department on July 9, 2022 . The unusual incident report was regarding Staff # 1(S#1) was serving lunch for all school age children outside Child # 1(C#1) and (C#2) saw and heard (C#3) ask (C#4) to touch his private part and (C#4) did. Both (C#1) and (C#2) get up and told (S#1).(S#1) told (S#2)

Upon arrival, LPA observed 8 infant, 19 pre-school, (16 school age children) and 8 staff member providing care.

During this inspection LPA conducted interview and completed a file review. In addition, LPA completed a safety inspection of the facility at approximately 01:20pm. In addition, during the inspection, LPA obtained copies of documentation related to the case management incident.

Due to the need to gather additional information, the case management will require further investigation.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted with Director Patricia Jacob's. A copy of the Appeal Rights (LIC 9058) were given and explained. Director signature on this form acknowledges receipt of these rights.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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