<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700174
Report Date: 12/29/2020
Date Signed: 12/29/2020 04:27:02 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:VIVIER FAMILY CHILD CAREFACILITY NUMBER:
367700174
ADMINISTRATOR:ELIZABETH VIVIERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 900-4244
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:14CENSUS: 0DATE:
12/29/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
04:17 PM
MET WITH:Elizabeth Vivier applicantTIME COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Steven Montoya conducted follow up pre licensing inspection to complete corrections. LPA provided technical assistance for applicant Elizabeth Vivier.

On 12-14-2020, LPA virtually inspected the applicants premise in order confirm health and safety guidelines to meet Title 22 regulations. Prior to being licensing, applicant was required to correct deficiencies.

Later that day, Licensee sent updated Mandated Reporter certificate sent to LPA via email. Today, LPA reviewed certificate and update file.

****Applicant sent LIC 809 for her own records. Applicant will review, sign, scan and return LIC 809 via email. As a result of this inspection, the home does meet Title 22 Regulations for licensing. All corrections have been resolved.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1