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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493173
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:14:30 PM


Document Has Been Signed on 01/10/2024 12:14 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 CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:TERRAZAS AND RUIZ FAMILY CHILD CAREFACILITY NUMBER:
197493173
ADMINISTRATOR:TERRAZAS, A & RUIZ, FFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 641-3900
CITY:SYLMARSTATE: CAZIP CODE:
91342
CAPACITY:14CENSUS: 9DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 PM
MET WITH:Florita Ruiz, LicenseeTIME COMPLETED:
11:50 PM
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On Wednesday, January 10, 2024 Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced follow up case management incident inspection regards the Unusual Incident Report received on 1/4/24 suspicion of child abuse.

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

An exit interview was conducted, during which this report and the Appeal Rights were discussed with Licensee Florita Ruiz.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024
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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