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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700200
Report Date: 11/08/2019
Date Signed: 11/08/2019 03:10:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:ADENIRAN, ADRIANNE FAMILY CHILD CAREFACILITY NUMBER:
197700200
ADMINISTRATOR:ADRIANNE ADENIRANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 920-3354
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:14CENSUS: 3DATE:
11/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Adrianne AdeniranTIME COMPLETED:
03:25 PM
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On November 8, 2019 at 2:00 pm Licensing Program Analysts (LPA) Phillips and King arrived at the above Child Care Home for the purpose of conducting a Case Management Inspection for an Incident that was cross reported from Childrens Residential Program on 11/04/19. LPA met with Licensee Adrianne Adeniran who inform LPA that since she has been licensed on 7/23/19, she has only provided care to extended family relative. Licensee states she lives in the home with 3 minor children. Licensee allowed LPA to speak with Child #1 and Child #2.

LPA interviewed Licensee, Child #1 and Child #2. Based on the information gather no additional investigation is needed at this time. If additional information is provided this case management will be re-visit.

An exit interview was conducted and a copy of this report was provided to Licensee.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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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