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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700448
Report Date: 11/03/2020
Date Signed: 11/04/2020 04:57:27 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:GOMEZ-CASTILLEJOS FAMILY CHILD CAREFACILITY NUMBER:
197700448
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
11/03/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:47 PM
MET WITH:Monica Gomez-CastillejosTIME COMPLETED:
12:48 PM
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Licensing Program Analyst (LPA) King-Lewis conducted a COVID-19 Emergency Response Tele-Visit Prelicensing Relocation Follow up Inspection with Applicant Monica Gones-Castillejos. Monica Gones-Castillejos showed LPA King the areas listed below and provided photos of the corrections:

Fireplace screened is secured to avoid falling or tip over


Child Safety Knobs installed on stove
Tall wall cabinet in day care napping room has been moved, Applicant stated the cabinet is now secure, to avoid falling on child.

During this inspection facility was observed to be in compliance with Title 22. The application for Small Family Child Care Home with a maximum capacity of 006 or 0008 with parent notification will be submitted for approval once the applicant complete and return the COVID-19 Self-Assessment form and this document is sign by the applicant and return and placed in the applicant file.

An exit interview was conducted, and a copy of this report was provided to the applicant on this date.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2020
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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