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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844287
Report Date: 03/15/2023
Date Signed: 03/17/2023 11:41:08 AM


Document Has Been Signed on 03/17/2023 11:41 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:JACKSON FAMILY CHILD CAREFACILITY NUMBER:
364844287
ADMINISTRATOR:JACKSON, LATOYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 373-6251
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:14CENSUS: DATE:
03/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Latoya Jackson TIME COMPLETED:
12:01 PM
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On 03/15/23 LPA Beneroso attempted to conduct an annual inspection of the Jackson Family Child Care Home but was unsuccessful due to licensee not being present. LPA was greeted by Licensee's daughter Latoya Jackson who informed LPA the licensee was not present at the moment.

LPA will attempt to conduct annual inspection in the near future.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Barbara BenerosoTELEPHONE: (661) 202-3411
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
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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