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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364816250
Report Date: 08/19/2019
Date Signed: 08/19/2019 10:24:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VANDERLINDEN FAMILY CHILD CAREFACILITY NUMBER:
364816250
ADMINISTRATOR:VANDERLINDEN, CYNTHIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 633-7023
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:14CENSUS: 6DATE:
08/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Cynthia Vanderlin/LicenseeTIME COMPLETED:
09:30 AM
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Licensing program analyst (LPA) Patricia Berry conducted an unannounced case management visit to follow up on a Confirmation of Removal for Aaron Prisock, which was issued on 8/15/19. LPA met with Cynthia Vanderlinden, Licensee. LPA toured facility and took census.

LPA explained the written Confirmation of Removal for Prisock. Vanderlinden stated Prisock is the boyfriend. Vanderlinden stated her boyfriend has never lived in her home or does not come to her home during day care hours. On 8/18 during the visit LPA received the signed Confirmation of Removal form stating Prisock does not live in the home.


Based on evidence obtained during todays' visit, the LPA has verified the individual is not present, employed or residing in the facility. LPA has advised the licensee to update the her roster.


An exit interview was conducted with licensee and a notice of site visit issued. LPA observed licensee post notice.


Verification of removal is complete.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019
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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