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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364814955
Report Date: 03/15/2022
Date Signed: 03/15/2022 10:35:06 AM

Document Has Been Signed on 03/15/2022 10:35 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:MALONE FAMILY CHILD CAREFACILITY NUMBER:
364814955
ADMINISTRATOR:MALONE, BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 843-9656
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Brenda Malone Licensee TIME COMPLETED:
10:32 AM
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Licensing Program Analyst (LPA) Steven Montoya met with licensee to finalize Complaint investigation: Proof of Correction (POC). At the time of the visit, licensee had no children in care.

During the inspection The facility was cited for (2) Type A deficiency (1) and (2). and (1) Citation Type B deficiency (3). Licensee left day care child unattended; Day care child sustained injuries while in care; Licensee did not notify day care child's authorized representative of the incident in a timely manner.

Licensee provided written statement for POC clarifying plans on all three allegations cited. Licensee agrees to provide supervision at all times. Licensee will provide a safe environment for children to grow. Licensee will report all injuries in accordance to rules and regulations.

Licensee was provided with a copy of the report and appeals rights. Exit interview.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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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