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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364815076
Report Date: 08/22/2019
Date Signed: 08/22/2019 10:29:45 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
364815076
ADMINISTRATOR:LOPEZ, RUTHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 900-6747
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 4DATE:
08/22/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Ruth LopezTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Neal met with licensee, Ruth Lopez for the purpose of a Case Management Inspection to verify that the Plan of Correction (POC) was completed. There were 4 child care children present during this inspection.

Licensee completed the following corrections by the POC due date from the Random Inspection that was conducted at an earlier date:
--Pediatric CPR/1st aid expires 5/11/2021.
--Licensee has an operable fire extinguisher.
--LPA observed that the opening to pool gate self-latches and self-closes.

No deficiencies were cited during this inspection. Notice of Site Visit was given to licensee to be posted for 30 days.

Exit interview was conducted and a copy of this report was given to the licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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