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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153805521
Report Date: 02/26/2020
Date Signed: 02/27/2020 10:37:36 AM

COMPREHENSIVE INSPECTION
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:MARIA'S CHILD CAREFACILITY NUMBER:
153805521
ADMINISTRATOR:LOPEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 390-4053
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:14CENSUS: 4DATE:
02/26/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:28 PM
MET WITH:Maria LopezTIME COMPLETED:
03:45 PM
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This report was generated to rectify the type of inspection conducted on 2/26/20. LPA Esequiel Rodriguez mistakenly under the Type of Visit drop arrow selection chose Case Management-Other instead of Required - 1 Year, It was not until the final print was conducted that the mistake was discovered.

Licensee was notified of the mistake and provided copy of this report.

See Facility Evaluation Report, LIC 809 titled Case Management - Other dated 02/26/2020 for full account of the Annual Required inspection.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Esequiel RodriguezTELEPHONE: (323) 981-3315
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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