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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191223990
Report Date: 04/30/2024
Date Signed: 04/30/2024 02:09:17 PM

Document Has Been Signed on 04/30/2024 02:09 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:HASTINGS FAMILY DAY CAREFACILITY NUMBER:
191223990
ADMINISTRATOR/
DIRECTOR:		HASTINGS, CONNIE LYNNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 272-5605
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
04/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Connie Hastings, Licensee TIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 04/30/2024 at 2:00 PM, Licensing Program Analyst (LPA) Justeene Tamayo conducted a Case Management Inspection and met with Licensee Connie Hastings to deliver a copy of the Decision and Order dated 03/27/2024 concerning the Exclusion Order for individual, Justin Mcintosh. LPA observed 1 infant, and 2 preschool children in care.

During the visit, LPA Tamayo explained the details of the Exclusion Order. The licensee stated that Justin Mcintosh has not been present at the facility for approximately two years. The exclusion was ordered to be effective on 04/08/2024. The requirements of the exclusion and the requirement to notify all parents of the exclusion were also discussed. A copy of the Notification of Parent's Rights (LIC995A) and the Addendum Regarding Exclusion (LIC995B) were provided to the licensee. The licensee was advised that for every children’s file the addendum is not in, a civil penalty of $100.00 will be assessed. The licensee indicated that she understood the Exclusion Order.

The licensee confirmed that she understands that Justin Mcintosh has been excluded from all State Licensed facilities and he must not return to the facility for any reason.

A copy of this report was provided to the licensee, along with the Notice of Site visit to be posted for 30 days.

An exit interview was conducted, and a copy of this report was provided to the Licensee on this date.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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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