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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415236
Report Date: 01/03/2020
Date Signed: 01/03/2020 03:50:16 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:AGUILAR FAMILY CHILD CAREFACILITY NUMBER:
197415236
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
01/03/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Deborah AguilarTIME COMPLETED:
04:00 PM
NARRATIVE
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On January 3, 2020, Licensing Program Analyst (LPA) Loyce Phillips arrived met with licensee, Deborah Aguilar for the purpose of a case management - deficiency. During an inspection for a complaint conducted on 1/3/2020, LPA observed the following deficiency:

Licensee's fail to have complete records for children in care.

Licensee was cited a Type B deficiency, according to California Code of Regulations Title 22 See LIC 809D for details. Appeals rights were given.

Exit interview was conducted, report was signed and a copy of this report was given to licensee Deborah Aguilar.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: AGUILAR FAMILY CHILD CARE
FACILITY NUMBER: 197415236
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2020
Section Cited

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Admission: Child Authorized Representative at time of acceptance the licensee shall provide authorized representative with a copy of the notice Family Child Care Home Notification of Parents’ Rights, LIC 995A. and other forms. This requirement was not met by evidence LPA did not observed children's files to be complete with forms.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 305-5243
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2020
LIC809 (FAS) - (06/04)
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