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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364811907
Report Date: 07/08/2021
Date Signed: 07/08/2021 07:13:38 PM

Document Has Been Signed on 07/08/2021 07:13 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:CURTIS FAMILY CHILD CAREFACILITY NUMBER:
364811907
ADMINISTRATOR:CURTIS, PARISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 522-2208
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
07/08/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
06:15 PM
MET WITH:Child # 1TIME COMPLETED:
07:23 PM
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At about 6.08 PM Analyst Mabika went to 7918 Midhurst Drive in Highlands, CA to interview the victim (Child) involved in the Curtis FCCH Complaint filed with the RO.

LPA Mabika introduced self and gave out his business card. LPA interviewed and qualified the 3 year old before interviewing the child without input from the mother.

LPA then went on to interview the complainant further and requested more evidenced be sent to LPA in the form of screen shots and text messages between complainant and attending deputy, complainant and Licensee.

Exit interview was held with complainant and emphasis was given to send in more evidence via email.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Aaron Mabika
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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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