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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808740
Report Date: 08/12/2021
Date Signed: 08/12/2021 06:21:53 PM

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:ARVIN STATE PRESCHOOL EL CAMINO REAL CAMPUSFACILITY NUMBER:
153808740
ADMINISTRATOR:BEATRICE GREYFACILITY TYPE:
850
ADDRESS:911 EL CAMINO REALTELEPHONE:
(661) 854-6661
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY:24CENSUS: DATE:
08/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angelica Salinas - Program Director TIME COMPLETED:
10:35 AM
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An unannounced Case Management inspection was conducted today by Licensing Program Analyst (LPA) Jessika Thompson. LPA met with Program Director Angelica Salinas. and toured the facility.

LPA Thompson conducted an unannounced Annual Required inspection on 8/06/21; due to computer issues, LPA Thompson was unable to provide staff with a copy of the LIC809, LIC809-C, associated to the inspection. On this date, LPA provided Ms. Salinas with all related reports.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies cited on this report.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: (559) 341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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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