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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492782
Report Date: 08/29/2023
Date Signed: 08/29/2023 02:02:33 PM


Document Has Been Signed on 08/29/2023 02:02 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:FIGUEROA FAMILY CHILD CAREFACILITY NUMBER:
197492782
ADMINISTRATOR:FIGUEROA, SARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 998-7341
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:14CENSUS: 6DATE:
08/29/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Daisy GuevaraTIME COMPLETED:
02:15 PM
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On 8/29/2023, the Licensing Program Analyst (LPA) Carol Heath conducted a Case Management (Other) Inspection. The licensee’s assistant Daisy Guevara opened the door for the LPA. The licensee, Sara Figueroa was not in the facility. According to the assistant, she went to pick up the school age children. The purpose of the inspection was to ensure that the home meets Licensing Title 22 Criminal Record Clearance regulations. The licensee’s adult son is no longer associated with the facility due to the exemption Denial.

The assistant called the licensee, Sara Figueroa. LPA spoke to the licensee on the phone. The licensee will not be home until 3:00 PM. LPA will revisit the facility later.
LPA left the Declaration for the licensee to fill out. In addition, LPA requested the licensee to provide her son’s new address and phone number.

Exit interview conducted and report was reviewed with the licensee’s assistant Daisy Guevara.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Carol HeathTELEPHONE: (661) 202-3709
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023
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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