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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191223990
Report Date: 09/05/2023
Date Signed: 09/05/2023 10:56:18 AM

Document Has Been Signed on 09/05/2023 10:56 AM - 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:HASTINGS, CONNIE LYNNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 272-5605
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
09/05/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Connie HastingsTIME COMPLETED:
11:30 AM
NARRATIVE
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On 9/5/2023, the Licensing Program Analyst (LPA) Carol Heath conducted a Case Management (Other) Inspection. LPA Heth met with the licensee, Connie Lynne Hastings. The purpose of the inspection was to follow up on the email received from the Legal Division and ensure the family childcare facility meets Licensing Title 22 regulations.
According to the Legal Division report, in 2020, Person #1 (See LIC 811) was arrested due to domestic violence and drugs. There was one daycare child present during the search warrant. The Palmdale Regional Office did not receive a phone call or UIR report from the licensee, Connie Lynne Hastings.

Based on the interview, observation and file/record review, the licensee failed to report an unusual incident as required on 2020.

Deficiencies cited: (See LIC 809D). The following Type B deficiencies are being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes.

An exit interview was conducted, and the report was reviewed with the licensee, Connie Hastings.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2023
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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Document Has Been Signed on 09/05/2023 10:56 AM - It Cannot Be Edited


Created By: Carol Heath On 09/05/2023 at 10:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HASTINGS FAMILY DAY CARE
FACILITY NUMBER: 191223990

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2023
Section Cited
CCR
102416.2(f)(2)

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Reporting Requirements: Reportable acts of violence include, but are not limited to those that occur whenever any child in care is a victim of, or subjected to witnessing, others' use of great physical force resulting in bodily harm, or dangerous activity,
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The licensee will report any situation to the Regional office in 24 hours and fill out LIC 624 B and submit in 7 days.
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such as illegal drug use or gunfire.This requirement is not met as evidence by:

Based on observation and interviews, the
licensee did not report 2020 incident which
poses an Potential Risk Health, Safety or
Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claretta Yates
LICENSING EVALUATOR NAME:Carol Heath
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2023


LIC809 (FAS) - (06/04)
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