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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364816549
Report Date: 04/08/2022
Date Signed: 04/08/2022 02:19:06 PM


Document Has Been Signed on 04/08/2022 02:19 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:
364816549
ADMINISTRATOR:GARCIA, ANDREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 948-5727
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 3DATE:
04/08/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Andrea Garcia licenseeTIME COMPLETED:
02:28 PM
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Licensing Program Analyst (LPAs) Steven Montoya conducted an unannounced CM Health and Safety inspection at the above facility. Upon arrival, the LPA met with licensee, who guided the LPA to tour of the facility. Individuals reside in the home include 2 adults (licensee, Claudia assistant). Per LIS, facility annual fees are current. All adults living in the home have been background cleared. Per licensee, the hours of operation are Monday through Friday 3:00 a.m. to 4:00 p.m.

The Home is set up as follows:
This is a two story house with 4 bedrooms, 3 bathrooms, kitchen/dining room, family/daycare room, living room, and attached garage. Per Licensee the living room, and family room/kitchen, 1 bathroom are utilized for the family child care activity area. Per licensee off-limit areas of the home is the all bedrooms, master bathroom, laundry room, and garage. The home was inspected for safety, comfort, cleanliness, telephone service, central air and heat and ventilation.

Main seperate Area: Main care will be inspected living room and family room and backyard.

Family room/ Daycare area: In the living room which is the designated day care and playroom, LPA observed age-appropriate toys and furniture for the children. There are games and books on the premises. There are mats on the floor which have educational/learning activities on them.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2022
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 364816549
VISIT DATE: 04/08/2022
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Continuation:

The mats were observed to be in good condition. The home has central heating and air conditioning. All windows have screens and are free of cracks, bugs, and debris. Hanging window blinds cords are inaccessible to children.

Backyard: LPA inspected backyard which appears to be in good standing and meets title 22 regulations. Licensee has four large great pyrenees dogs who are vaccinated. License provided proof of vaccinations. LPA observed a green house structure in the backyard for fruit and vegetable which is under construction. LPA received a copy of the Faciltiy Roster which licensee reports is up too date.

Deficiencies cited: None.

Notice of Site Visit: A notice of site visit was given and must remain posted for 30 days.

Exit interview and report with appeal rights was reviewed with the licensee Andrea Garcia.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 202-4701
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2