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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700236
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:28:50 AM

Document Has Been Signed on 01/17/2024 11:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:YARBER FAMILY CHILD CAREFACILITY NUMBER:
367700236
ADMINISTRATOR:HEATHER YARBERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 519-1444
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
01/17/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Amencia Theus, AssistantTIME COMPLETED:
11:30 AM
NARRATIVE
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On January 17, 2024, Licensing Program Analyst (LPA), Calloway made an unannounced Case Management inspection to the facility above. LPA met with the Assistant who granted access. Licensee was not home during the inspection. LPA toured inside and outside and observed two (2) staff and nine (9) day care children in active play outside.

During the inspection, LPA obtained a copy of the child/parent roster that with incomplete, missing physician information. Thirteen (13) day care children did not have full name, date of birth, or physician information, and one child that was not on the roster, yet was in care.

Per Title 22 Regulations, There is one Type B deficiency cited during this inspection for 102417(g)(8)- Operations of a Family Child Care Home. See 809 D page.

Exit interview was conducted and a copy of this report was read, a Notice of Site Visit, and Appeal Rights were provided to Amencia Theus, Licensee's assistant at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a $100 civil penalty.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kuliema Calloway
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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 01/17/2024 11:28 AM - It Cannot Be Edited


Created By: Kuliema Calloway On 01/17/2024 at 11:16 AM
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: YARBER FAMILY CHILD CARE
FACILITY NUMBER: 367700236

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2024
Section Cited
CCR
102417(g)(8)

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102417(g)(8)-(g)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include...(8)Each family child care home shall have...current roster of children...Health/Safety Code...This requirement was not met as evidenced by:
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Per Assistant, current roster will be completed, maintained, and submitted to Licensing by chosen POC date of 1/31/24.
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Based on observation, interview, and record review. The day care roster was incomplete and there was one child in care that was not on the roster. This poses a potenital health, safety, or personal rights risk to the persons in care.
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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:Kuliema Calloway
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024


LIC809 (FAS) - (06/04)
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