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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700067
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:19:40 PM

Document Has Been Signed on 08/01/2023 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:WILLIAMS FAMILY CHILD CAREFACILITY NUMBER:
367700067
ADMINISTRATOR:WILLIAMS, DEMETRIUS&MAXINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 838-7668
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ashley Arana RuizTIME COMPLETED:
02:58 PM
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On 8.1.23, LPA arrived at the Family Childcare Home (FCCH) to conduct an unannounced annual/random inspection. LPA met with Assistant, Ashley Arana Ruiz. Licensee left for a family emergency. At the time of the visit, LPA observed 14 children and 2 assistants. The assistants have fingerprint clearance and first-aid/CPR. Assistants did not know where the files for the children and themselves were. Assistant disclosed that licensee should return to the home next week.

LPA attempted to contact licensee. LPA had home phone number listed. LPA will return to complete inspection at a later date.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Kristina Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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