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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150405677
Report Date: 08/22/2019
Date Signed: 08/22/2019 04:42:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:LION'S DAY CARE / PRESCHOOLFACILITY NUMBER:
150405677
ADMINISTRATOR:SIMON, DEBORAFACILITY TYPE:
850
ADDRESS:3012 MT. PINOS WAYTELEPHONE:
(661) 245-1139
CITY:FRAZIER PARKSTATE: CAZIP CODE:
93225
CAPACITY:28CENSUS: 10DATE:
08/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Debora SimonTIME COMPLETED:
04:41 PM
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Licensing Program Analyst(LPA),Ortega met with Director Debora Simon, for a Case Management inspection involving a report dated June 11, 2019. The incident occurred on June 6, 2019.

Interviews were conducted with children and parents. Child #2 was not present on this day.

Based on information provided and interviews conducted the incident needs further investigation. An exit interview was conducted and a copy of this report was read and provided to the Assistant Director, Debora Simon on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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