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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808632
Report Date: 04/29/2022
Date Signed: 04/29/2022 11:04:08 AM


Document Has Been Signed on 04/29/2022 11:04 AM - 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:DURAN FAMILY CHILD CAREFACILITY NUMBER:
364808632
ADMINISTRATOR:DURAN, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 337-7739
CITY:LAKE ARROWHEADSTATE: CAZIP CODE:
92352
CAPACITY:14CENSUS: 9DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Licensee Monica Duran TIME COMPLETED:
11:15 AM
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
On 4/29/2022, License Program Analyst (LPA) Zirbes conducted an unannounced case management inspection at the family child care home. The purpose of the inspection was to complete a health and safety check. LPA announced the reason for the unannounced inspection and the Licensee granted LPA access to the home.

A total of nine child care children and two staff members were present when LPA arrived on grounds. The facility currently meets the capacity and ratio requirements. A safety inspection was completed at 10:35am. No deficiencies were noted.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Monica Duran.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Kendal ZirbesTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022
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