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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844573
Report Date: 07/22/2019
Date Signed: 07/22/2019 02:10:49 PM

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:BROWN FAMILY CHILD CAREFACILITY NUMBER:
364844573
ADMINISTRATOR:BROWN, DELANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 881-3291
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:14CENSUS: 8DATE:
07/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Delana BrownTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Thompson-Miller met with Licensee, Delana Brown. LPA conducted a Case Management - Other inspection. Upon arrival LPA observed 8 children napping (6 preschool, 2 infants) along with assistant and licensee. The purpose of the inspection is to verify individual October Brown is not residing, working or is present in the licensed family child care home (FCCH). A tour of the home was conducted.

Declaration provided from Licensee regarding October Brown status at the facility. LPA provided a copy of the Caregiver Background Check Bureau letter (Immediate Action Required) dated June 24, 2019 to Licensee. A copy of CBCB-3 (Revision 12) Exemption Needed OUT, dated 07/17/2019 and signed by Licensee was provided to LPA on this date.

Exit interview and a copy of the report was read and provided to Delana Brown, Licensee on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Linda Thompson-MillerTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
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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