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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014759
Report Date: 03/02/2022
Date Signed: 03/02/2022 04:38:21 PM


Document Has Been Signed on 03/02/2022 04:38 PM - It Cannot Be Edited

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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
198014759
ADMINISTRATOR:GARCIA, CARLOTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 764-4376
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:14CENSUS: 5DATE:
03/02/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Carlota GarciaTIME COMPLETED:
04:49 PM
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An Unannounced Case Management Inspection was conducted on this date by Licensing Program Analysts (LPA’s) Justin Dorsey and Justeene Tamayo to provide the following letter:

--ORDER TO LICENSEE/FACILITY OF IMMEDIATE EXCLUSION FROM ALL FACILITIES

LPA’s informed Licensee Carlota Garcia that adult #1 is excluded from Garcia FCC and any other licensed facilities by the Department of Social Services. Licensee and adult #1 have 15 days to submit an appeal, the address for the appeal was provided to Licensee Garcia.

LPA’s advised Licensee the ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES letter will be served to adult #1. LPA Dorsey also gave a ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES letter to the licensee/assistant #1 to give to adult #1.

Exit interview conducted, appeal rights provided and explained. A copy of this letter was read and provided to Licensee Carlota Garcia. During the visit assistant #1 was present to help with translations between LPA's and Licensee.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2022
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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