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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700027
Report Date: 12/01/2022
Date Signed: 12/01/2022 12:50:51 PM


Document Has Been Signed on 12/01/2022 12:50 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 CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:COOPER-WARREN FAMILY CHILD CAREFACILITY NUMBER:
197700027
ADMINISTRATOR:COOPER-WARREN, MONIQUEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 718-9980
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:14CENSUS: DATE:
12/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Monique Cooper-WarrenTIME COMPLETED:
12:59 PM
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On 12/01/2022 Licensing Program Analyst (LPA) Ortega arrived at the Family Care Home to conduct a Case Management Inspection. At the time of arrival LPA observe one child in care(relative). According to licensee she is has not been caring for day care children only grandchildren for about a year.

Licensee stated she would like to be placed on inactive status due to medical reasons. Licensee is requesting an inactive status starting 12/01/2022 to 06/01/2023. Licensee submitted a request for inactive Child Care License status with signature dated today, 12/01/2022. Licensee is aware during inactive status no day care children may be enrolled and cared for until an annual required Inspection is conducted and license is reactivated.

Copy of this report, appeal rights and notice of site visit was provided to licensee.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
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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