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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808632
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:49:02 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:DURAN FAMILY CHILD CAREFACILITY NUMBER:
364808632
ADMINISTRATOR:DURAN, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 337-7739
CITY:LAKE ARROWHEADSTATE: CAZIP CODE:
92352
CAPACITY:14CENSUS: 14DATE:
12/17/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Licensee. Monica Duran TIME COMPLETED:
10:55 AM
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On December 17, 2021, Licensing Program Analyst (LPA) Kendal Zirbes conducted an unannounced Plan of Correction (POC) inspection. The purpose POC inspection was to clear deficiencies cited on December 8, 2021. Present during today’s inspection were 14 childcare children (two infants and 12 older children) and two staff members. LPA completed a tour with the Licensee.

Based on LPAs observations on this day the facility has corrected the deficiencies. A POC clearance letter was provider to the Licensee.

An exit interview was conducted, a copy of this report, and notice of site visit were provided to Licensee
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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