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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750030
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:59:04 PM

Document Has Been Signed on 10/03/2023 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: 0DATE:
10/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Patricia Jacobs,Director TIME COMPLETED:
12:29 PM
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On 10/03/23, Licensing Program Analyst (LPA) Justeene Tamayo met with Director Patricia Jacobs who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident Follow Up Inspection for an Unusual Incident that occurred on 09/26/23. The Unusual Incident was self reported within the time frame specified by regulations. Upon arrival, LPA observed 0 school age children in care.

Description of incident: On 09/26/23, staff noticed a water puddle in the kitchen, and it was determined the valve will need to be replaced on the water heater.

LPA toured the facility and observed the water heater replaced.

No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was provided to the Director, along with Notice of Site Visit and appeal rights.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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