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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418071
Report Date: 06/06/2023
Date Signed: 06/06/2023 12:00:30 PM

Document Has Been Signed on 06/06/2023 12:00 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
197418071
ADMINISTRATOR:FLORES, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 838-5594
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Erika FloresTIME COMPLETED:
11:50 AM
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On June 06, 2023, Licensing Program Analyst (LPA) Isabel Ortega met with Licensee, Erika Flores to conduct an unannounced Annual inspection. Licensee stated she has not been caring for children since 2020 due to decrease of enrollment during Covid-19 pandemic. Upon arrival, LPA did not observe any children in care.

During this inspection licensee completed a declaration surrendering her Family Child care Home license, capacity of 14 children(license number 197418071). Licensee is aware she may reapply for a Family child care Home (FCCH) in the further.

A notice of site visit was given and must remain posted for 30 days.

An exit interview was conducted, copy of this report and the Appeal Rights were discussed and given to Licensee, Erika Flores.

SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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