Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407897
Report Date: 06/11/2018
Date Signed: 06/11/2018 01:59:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:RIVERA FAMILY CHILD CAREFACILITY NUMBER:
197407897
ADMINISTRATOR:EDITH RIVERAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 287-1691
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY:14CENSUS: 5DATE:
06/11/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Edith RiveraTIME COMPLETED:
02:10 PM
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Licensing Program Analysts (LPA) Mason met with Licensee, Edith Rivera for a Case Management- Other inspection.

The purpose of the inspection is to conduct a health and welfare check to ensure facility has not been impacted by the recent fires.

A tour of the facility was conducted, and facility phone number was verified. The facility is operating within proper capacity and ratios. LPA observed the facility to be providing adequate care and supervision to the children in care. Licensee states the facility or children enrolled have not been impacted by the recent fires.


No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was read and submitted to Licensee Edith Rivera.

An exit Interview was conducted, a copy of this Report and a Notice of Site visit was provided.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Tiana MasonTELEPHONE: (661) 568-8186
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2018
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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