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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700328
Report Date: 09/27/2019
Date Signed: 09/27/2019 11:31:48 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:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
197700328
ADMINISTRATOR:GONZALEZ, PRISCILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 317-9720
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:14CENSUS: 6DATE:
09/27/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Priscilla Gonzalez, Licensee TIME COMPLETED:
11:42 AM
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On 09/27/19, Licensing Program Analysts (LPAs) Hunt and King conducted a visit to the Gonzalez Family Child Care Home to investigate an Unusual Incident reported to the Department by the licensee via telephone on 09/25/19. Upon arrival, there were 6 children in care along withe the licensee and 2 staff.

Description of the incident: A incident occurred on 09/19/19 at approximately 7:00 p.m., in which child # 1, exited the home and was found outside by a neighbor who brought the child back to the home. At the time of the incident, the licensee was not present in the home due to the fact that she was shopping and purchasing supplies for the day-care. There were five children in care at the time of the incident. Children were being supervised by the licensee's assistant.

During today's inspection LPAs interviewed pertinent parties relevant to the investigation. LPAs will return to for follow up interviews.

LPAs advised licensee that a final determination has not been made and that further investigation is needed. An exit interview was conducted with the licensee and appeal rights were discussed. A copy of this report was left at the facility.



SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019
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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