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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000650
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:17:22 PM


Document Has Been Signed on 05/04/2022 03:17 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:BOND FAMILY CHILD CAREFACILITY NUMBER:
192000650
ADMINISTRATOR:BOND, OMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 946-5700
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: DATE:
05/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Oma Bond TIME COMPLETED:
03:26 PM
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Lady King-Lewis, Licensing Program Analyst (LPA) conducted an unannounced site inspection for the purpose of following up on an Unusual Incident report received in the Regional Office on 04/24/2022, for an incident that occurred on 004/22/2022.

LPA interviewed licensee, child 2 and child 4. LPA was unable to interview child 1 due to child 1 no longer attend the daycare and child 3 was not in attendance at the time of this Case Management inspection.

LPA received a copy of the Child Care Facility Roster

Further information is need

An exit interview was conducted, and a copy of this report was provided to the facility Director.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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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