<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700379
Report Date: 03/09/2020
Date Signed: 03/09/2020 02:20:53 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
FACILITY NAME:FOX FAMILY CHILD CAREFACILITY NUMBER:
197700379
ADMINISTRATOR:FOX, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(302) 312-3042
CITY:SANTA CLARITASTATE: CAZIP CODE:
91387
CAPACITY:14CENSUS: 9DATE:
03/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Cheryl Fox, LicenseeTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A pre-licensing change of location inspection was conducted on 03/03/2020 by LPA Monique Ayala and LPM Mariela Ramon. Today 03/09/2020, LPA Ayala met with licensee for the purpose of obtaining a declaration from the licensee concerning the off limit area of the home which include a bedroom that gives direct access to the backyard area where the swimming pool and spa are located.

On 03/03/2020, licensee disclosed the aforementioned bedroom will be off limits to the day care children. Licensee will make the bedroom in accessible by keeping the bedroom door locked, including the door that gives direct access to the backyard.

Licensee has updated the facility sketch to reflect the bedroom as an off limits area to the day care children.

During this inspection, LPA was provided with licensee's declaration and an updated copy of the facility sketch.

An exit interview was conducted with the licensee and a copy of this report was provided.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1