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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493079
Report Date: 06/15/2021
Date Signed: 06/15/2021 10:50:22 AM

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:OLIVE VIEW INFANT-CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197493079
ADMINISTRATOR:CLAUDIA REYESFACILITY TYPE:
850
ADDRESS:14445 OLIVE VIEW DR.BLDG. 120TELEPHONE:
(818) 364-3444
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:52CENSUS: 26DATE:
06/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:CLAUDIA REYESTIME COMPLETED:
11:15 AM
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On 06-15-21, Licensing Program Analyst (LPA) Lady King-Lewis arrived a the facility to conduct a case management visit. The purpose of the case management visit was to follow-up on a self reported Unusual Incident Report submitted by the facility on 06-11-21.

During the visit, LPA took a census of the children present, and met with Center Director, Claudia Reyes to discuss the reported incident. During the visit, LPA spoke with child's teacher concerning the incident as well as child #1. child # 1 showed LPA the out door play area where child fell and how she fell. LPA observed the play area to be safe and hazard free, no cracks in the concrete that would cause a child to fall.

LPA received a copy of the Child Care Facility Roster and a copy of the preschool class roster.

An exit interview was conducted, a notice of site visit given and informed to be posted for 30 days.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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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