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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367750030
Report Date: 08/30/2022
Date Signed: 08/30/2022 04:39:56 PM

Document Has Been Signed on 08/30/2022 04:39 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: 23DATE:
08/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Patricia Jacob'sTIME COMPLETED:
04:49 PM
NARRATIVE
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On August 30, 2022, Licensing Program Analyst (LPA) Babatunde Ibitoye made an unannounced visit for the purpose of delivering findings for the Unusual Incident received on 07/09/2022. LPA Met with Director Patricia Jacob’s . There are 23 day-care children present with 3 staffs member providing care.

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)

Based on the evidence obtained, it is determined Child # 3 and Child #4 engaged in inappropriate conduct.

This is corroborated by interviews, observations, and agency reports. Therefore, based on the evidence gathered. It is determined that a Personal Right violation of the California Code of Regulations, Title 22, Division 12, Chapter 3, Sections 101223(a)2 occurred.

Deficiencies are cited on LIC 809D.

The Notice of Site Visit must be posted for 30 days. Furthermore, upon receipt, the Director shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted with and a copy of this report has been signed by and provided to Director (Patricia Jacob’s), Site Visit and Appeal Rights were given.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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Document Has Been Signed on 08/30/2022 04:39 PM - It Cannot Be Edited


Created By: Babatunde Ibitoye On 08/30/2022 at 03:55 PM
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 INC.
FACILITY NUMBER: 367750030

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2022
Section Cited
CCR
101223(a)2

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: Personal Rights. Each child shall be accorded safe, healthful, and comfortable accommodations, furnishing, and equipment. healthful, and comfortable accommodation. Based on the interview and record review this requirement was not met as the licensee failed to ensure a safe, healthful, and comfortable accommodation which resulted in children engaging in inappropriate conduct. This poses potential health, safety, or personal rights risk to a person in care.
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Child #3 was Desenrolled immediately because of his inaappropriate behavior, for the safety of all children



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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:Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022


LIC809 (FAS) - (06/04)
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