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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014759
Report Date: 06/28/2022
Date Signed: 06/28/2022 02:55:03 PM


Document Has Been Signed on 06/28/2022 02:55 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:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Carlota GarciaTIME COMPLETED:
03:09 PM
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License Program Analyst (LPA) Justin Dorsey conducted a Case Management - Other inspection at Garcia Family Child Care Home. LPA met with Licensee Carlota Garcia. The purpose of the visit was to complete a health and safety check.

At the time of inspection there was 5 children with licensee Carlota Garcia. Also present in the home was Adult #2 and Adult #3. LPA Dorsey inspected all areas of the home for health and safety compliance. During the visit Adult #1 was not observed to be in the home.

A copy of the report and appeals right were left with the licensee as well as the notice of site visit. Adult #2 was present during the inspection to translate the report.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (661) 305-3012
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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