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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841901
Report Date: 02/25/2020
Date Signed: 02/25/2020 12:56:10 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:ARCHILA FAMILY CHILD CAREFACILITY NUMBER:
364841901
ADMINISTRATOR:VILMA ARCHILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 628-6705
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:14CENSUS: DATE:
02/25/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Vilma ArchilaTIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) Hunt conducted a Case Management inspection for the purpose of delivering the Non-Compliance Conference ( NCC) Notification Letter. During this inspection LPA met with Vilma Archilla, licensee.

LPA discussed and explained the purpose of the Non- Compliance Conference to licensee and the date was changed to 03/10/20 at 10:00 address and location TBA.

An exit interview was conducted and a copy of this report, notice of site visit and was read and provided to the licensee, Vilma Archilla on this date 02/25/20.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Victoria HuntTELEPHONE: (661) 568-8930
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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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