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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412222
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:36:07 PM


Document Has Been Signed on 02/17/2023 01:36 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:CABRERA FAMILY CHILD CAREFACILITY NUMBER:
197412222
ADMINISTRATOR:CABRERA, GUADALUPEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 965-1080
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY:14CENSUS: 6DATE:
02/17/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Guadalupe CabreraTIME COMPLETED:
01:50 PM
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On 02/17/23 Licensing Program Analysts (LPA's) Justin Dorsey and Kristina Diaz conducted an inspection at Cabrera FCC. The purpose of the inspection was a Plan of Correction visit to review the deficiency cited on 02/10/23. LPA's met with Licensee Guadalupe Cabrera and toured the facility.

The following was observed:
1.) LPA Dorsey observed all areas of the home and observed Adult #2 or any uncleared adult was not present in the home.
2.) LPA's observed that the gate blocking the homes stairs was broken but still functioning. LPA Dorsey advised licensee that the gate must be replaced.

Exit interview conducted over the phone with Adult #1 a copy of this report, Notice of Site Inspection and Deficiency Clearance Letter was left with Guadalupe Cabrera.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023
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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