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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418643
Report Date: 06/15/2023
Date Signed: 06/15/2023 11:57:49 AM


Document Has Been Signed on 06/15/2023 11:57 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:SAAVEDRA FAMILY CHILD CAREFACILITY NUMBER:
197418643
ADMINISTRATOR:SAAVEDRA, CONNYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 336-6954
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 0DATE:
06/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Connie SaavedraTIME COMPLETED:
12:12 PM
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On 06/15/23, Licensing Program Analyst (LPA) Justin Dorsey met with Licensee, Connie Saavedra to conduct an unannounced Annual inspection. Per licensee the she has not had children in care since 12/2022 and would like to close the family child care home. According to the licensee she does not live in the home and will re-apply for a new license when she has a new address. During the visit LPA did not observe any children in care.

During this inspection licensee completed a declaration surrendering her family child care home license. Licensee is aware she can reapply for a family child care home and the family child care license does not transfer to different addresses. Per licensee she will mail the child cares original license to the Community Care Licensing Office.

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, Connie Saavedra.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/15/2023
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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