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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418839
Report Date: 10/25/2019
Date Signed: 10/25/2019 01:03:17 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:DIEGUEZ FAMILY CHILD CAREFACILITY NUMBER:
197418839
ADMINISTRATOR:DIEGUEZ, EDITH & ELSIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 481-6858
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY:14CENSUS: 12DATE:
10/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Edith DieguezTIME COMPLETED:
01:15 PM
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On 10/25/19 at 12:52 p.m., Licensing Program Analyst (LPA) Isabel Ortega was greeted by above facility's licensee, Edith Dieguez. LPA was at the facility to Amend findings dated on 10/08/19 regarding a complaint investigation. LPA disclosed the purpose of the inspection and was granted entry by the Licensee, who guided LPA on a tour of the facility. Upon entry LPA observed 12 children in care.

Complaint Investigation deficiency page report was Amended, and signature was obtained.

An exit Interview was conducted, a copy of this Amended report, a Notice of Site visit and appeal rights were provided to the licensee Edith Dieguez.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019
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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