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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750030
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:30:41 PM

Document Has Been Signed on 12/19/2023 02:30 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:
12/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Patricia Jacobs, Director TIME COMPLETED:
02:45 PM
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On 12/19/2023, 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 12/12/23. The Unusual Incident was self reported within the time frame specified by regulations. Upon arrival, LPA observed 0 school age children in care, along with 1 teacher and the Director.

Description of incident: On 12/12/2023, staff #1 was transporting school age children from their elementary school to the day care center, where another car hit the day care transportation van from the back. There were 10 school age children in the car along with staff #1.

From interviews conducted with staff, staff #1 took appropriate measures and ensured the health and safety of each child in the car. Staff #1 immediately called 911 and obtained a police report. All 10 children were checked by paramedics. Staff #1 also called the Director, and parents were notified. No doctors visit or medical attention was needed. The car accident was minor and accidental.

Director will be sending a copy of the police report to LPA Tamayo when the police report is ready.

No deficiencies have been cited at this time.

An exit interview was conducted and a copy of this report was read and provided to Director Patricia Jacobs, along with a copy of her appeal rights and Notice of Site Visit.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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