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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197700226
Report Date:
06/10/2019
Date Signed:
06/10/2019 04:56:26 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:
SANDOVAL FAMILY CHILD CARE
FACILITY NUMBER:
197700226
ADMINISTRATOR:
SANDOVAL, MELISSA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(818) 521-8868
CITY:
PALMDALE
STATE:
CA
ZIP CODE:
93551
CAPACITY:
14
CENSUS:
7
DATE:
06/10/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:19 PM
MET WITH:
Melissa Sandoval
TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Victoria Hunt conducted an unannounced case management inspection and met with licensee Melissa Sandoval to discuss the purpose of the visits. During today’s visit LPA toured the facility there were 7 children in care.
On 05/29/19 the Department received information from Caregiver Background Check Bureau (CBCB) pertaining to individual #1. Licensee stated she receive the notification of Notice of Exemption Denial Letter for individual #1. Licensee states that Individual #1 is no longer residing in the property. LPA obtained a declaration from licensee and her assistant N. Miller.
Exit interview was conducted a copy of this report was read and discussed with licensee.
SUPERVISOR'S NAME:
Mariela Ramon
TELEPHONE:
(661) 789-6952
LICENSING EVALUATOR NAME:
Victoria Hunt
TELEPHONE:
(661) 568-8930
LICENSING EVALUATOR SIGNATURE:
DATE:
06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/10/2019
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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