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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415948
Report Date: 04/18/2023
Date Signed: 04/18/2023 11:47:33 AM


Document Has Been Signed on 04/18/2023 11:47 AM - 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:BOGGS FAMILY CHILD CAREFACILITY NUMBER:
197415948
ADMINISTRATOR:BOGGS, KRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 802-4420
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:14CENSUS: 9DATE:
04/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kristina Boggs, LicenseeTIME COMPLETED:
12:00 PM
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On 04/18/23 Licensing Program Analyst (LPA) Justeene Tamayo met with licensee Kristina Boggs who guided LPA on a tour of the facility. The purpose of this visit was to conduct a Case Management - Incident inspection. This Unusual Incident was self-reported within the time frame specified by regulations. Upon arrival LPA observed 9 preschool children in care, along with assistant #1 and the licensee.

Description of incident: On 04/03/23 child #1 was taken to the emergency room by parent #1 due to child's elbow was hurting.

During this inspection, LPA interviewed staff and children present on 04/03/23, and obtained a copy of the facility roster as well as video footage.

During interviews and video footage obtained, it was revealed child #1 did not show any distress or pain at the facility.

The facility is found to be in compliance with Title 22 Regulations, and no deficiencies are being cited at this time.

An exit interview was conducted and a copy of this report was provided to the licensee, along with a Notice of Site Visit and appeal rights.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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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