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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700170
Report Date: 02/13/2024
Date Signed: 02/13/2024 12:26:19 PM

Document Has Been Signed on 02/13/2024 12:26 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:DONN FAMILY CHILD CAREFACILITY NUMBER:
197700170
ADMINISTRATOR:DONN, AMAKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 992-1401
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Amaka DonnTIME COMPLETED:
12:35 PM
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On 2/13/2024, Licensing Program Analyst (LPA) Carol Heath conducted an unannounced site visit and met with the licensee, Amaka Donn, for the purpose of the visit is to conduct a Case Management visit for exemption denial for person #1 (See LIC 811) issued by the Department on 1/18/2024. Upon arrival, LPA observed 2 children ( 13 and 2 years old) in the care of the licensee.

The licensee indicated that she did not receive the denial letter until 2/1/2024, and she removed personal #1 from the facility immediately. The licensee also stated person #1 is her adult son. The licensee stated that person #1 is living in the car in front of the facility’s street.

LPA Heath conducted a facility tour and observed male clothing, toiletries, shoes, and other personal male materials in the house for other family members. LPA asked the licensee to fill out the LIC 855 Declaration form to state that Personal #1 is not living in the house.

The licensee was informed that they have responded to the CBCB analyst regarding the exemption process.

The licensee was reminded that the uncleared son could not reside in the home or have contact with the children in care. The licensee was reminded of the civil penalties that may apply.

An exit interview was conducted, and a copy of this report was read and provided to the Licensee, Amaka Donn, along with a Notice of Site Visit.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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