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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417974
Report Date: 10/08/2020
Date Signed: 10/08/2020 02:36:38 PM

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:GUARDIAN ANGEL ACADEMYFACILITY NUMBER:
197417974
ADMINISTRATOR:ALICIA TORRESFACILITY TYPE:
830
ADDRESS:13413 BRADLEY AVENUETELEPHONE:
(818) 362-2526
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:13CENSUS: 12DATE:
10/08/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Diane Ferguson-LicenseeTIME COMPLETED:
12:30 PM
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 On 10/8/2020 at 10:30 AM, Licensing Program Analyst (LPA) Nadia Flores conducted a technical assistance inspection for the purpose of a waiver request. LPA met with Licensee Diane Ferguson virtually via FaceTime due to COVID-19 Emergency Response. There were a total of 12 children in care and 5 teachers. Licensee requested to provide care for 6 school age children in which the center has designated 1 teacher to supervise. This would allow the children of families who already have children who attend the center keep the siblings together.

LPA Flores and licensee reviewed the conditions of waiver and Licensee gave LPA a tour of the area where the school age children will be participating in their distance learning.

Facility has designated one Preschool room with a bathroom for the 6 school age children. Age appropriate supplies were visible along with digital material for children to do distance learning. The room is able to accommodate 6 children and maintain 6ft apart for social distancing. The bathroom is composed of two toilets with a partition and one sink inside and outside of the bathroom. Licensee stated that supervision will always present while children go to the restroom.

School age children will be able to play outside on a staggered playtime schedule, and will not commingle with other pre-school children.

LPA observed the approved waiver on the wall where parent can easily view. In addition LPA discussed the importance of providing parent with a copy of this waiver. LPA also informed licensee that the waiver has an expiration date and should she require an extension, a request must be made to the Regional Office.

LPA provided a copy of this report to licensee on this date via email with a read receipt requested on this date..

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Nadia FloresTELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2020
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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