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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700305
Report Date: 09/12/2019
Date Signed: 09/12/2019 09:14:58 AM

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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
197700305
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/12/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maria GarciaTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Neal met with Maria Garcia today for the purpose of conducting a Pre-licensing inspection of Corrections for a small family child care home.

The corrections were verified as follows:

1) Resident's (Applicant's daughter) proof of TB clearance was submitted.
2) Applicant's proof of the measles immunization was submitted.
3) LPA observed operable carbon monoxide detector.
4) Pool gate meets regulations (5 ft high, with appropriate width between bars. The 2 gates swing outward and are self-latching/self-closing).
5) Stairs observed gated. Additional gates have been added to the area where child care will be used.
6) Knives have been made inaccessible (child locked drawer).

Application for a small family child care home will be submitted for approval.

Exit interview was conducted and a copy of this report was given to the applicant.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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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