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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700191
Report Date: 07/20/2022
Date Signed: 07/21/2022 04:43:35 PM


Document Has Been Signed on 07/21/2022 04:43 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/21/2022 04:30 PM

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

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At this time this report is being amended today 07/21/2022 to update some information on this report.

On 07/20/2022, Licensing Program Analysts (LPAs) Justeene Tamayo and Barbara Beneroso conducted a Case Management inspection for the purpose of reviewing the condition of the Revised Decision and Order dated 06/28/22. Present during the time of this inspection is licensee, licensee’s assistant, and 9 day care children. LPAs toured the home.

The license is placed on probation for three years effective 06/28/22 through 06/28/25 with the following conditions:

1. Obey all laws and regulations, including the California Community Care Facilities Act, and adhere to all Department regulations promulgated thereunder.
2. Licensee shall report to the Department, as the Department may direct, such information concerning any of her activities for which a license to operate a family child care home is required.
3. Should licensee violate probation in any respect, the Department may, after giving notice and opportunity to be heard, revoke probation and carry out the disciplinary order which was stayed. If an Accusation or Petition to Revoke Probation is filed against licensee during probation, the probation shall be extended until the Department issues a final decision.
4. Upon successful completion of probation, licensee's license shall be fully restored.

Licensee has read and acknowledges the understanding of the Departments Manual of Policies and Procedures for Family Child Care Homes. Licensee has provided an affidavit to the Department within 30 days of the effective date of this decision.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: DUNN, RODEEN FAMILY CHILD CARE
FACILITY NUMBER: 197700191
VISIT DATE: 07/20/2022
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Licensee understands that if she fails to comply with the terms and conditions above, the Department may lift the stay and revoke Licensee's license.

Licensee was also advised that she has been placed on required inspections. Licensee was provided with a copy of the Probationary License during this inspection.

LPAs advised the licensee that per the decision and order she must notify parents of her probationary license, must provide copies of the decision and order and must comply with licensing regulations and the terms of the decision in order.

During this visit conducted today on 07/20/2022, no deficiencies are being cited at this time.

An exit interview was conducted, a copy of this report along with the appeal rights was provided to Licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Justeene TamayoTELEPHONE: 661-202-3796
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC809 (FAS) - (06/04)
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