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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700007
Report Date: 07/11/2019
Date Signed: 07/11/2019 02:08:50 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
367700007
ADMINISTRATOR:ADRIANA RODRIGUEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 596-3130
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:14CENSUS: 7DATE:
07/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Adriana RodriguezTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Neal met with Licensee, Adriana Rodriguez today for the purpose of signing and giving a copy of the electronic report for a Capacity Increase inspection done on 6/26/2019 to the licensee. On 6/26/2019, LPA Neal experienced technical difficulties with computer and was unable to sign LIC 809 during the inspection completed.

During today's inspection, LPA delivered the license to licensee. There were 7 child care children present during this inspection.

Notice of Site Visit was given to be posted for 30 days.

Exit interview was conducted, report was signed and a copy of this report was given to the licensee.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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