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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412416
Report Date: 02/13/2020
Date Signed: 02/13/2020 11:08:30 AM

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:LEDEZMA FAMILY CHILD CAREFACILITY NUMBER:
197412416
ADMINISTRATOR:LEDEZMA, MARTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 893-8691
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY:14CENSUS: 3DATE:
02/13/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Matha LedezmaTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Maddox conducted a Plan of Correction (POC) inspection today to clear citation issued 10/25/19. During this unannounced inspection, LPA verified Assistant now has current immunizations. Citation as been cleared.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Donna MaddoxTELEPHONE: (661) 568-8971
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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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