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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153801390
Report Date: 07/27/2021
Date Signed: 07/27/2021 10:37:48 AM

Document Has Been Signed on 07/27/2021 10:37 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:BUENA VISTA MIGRANT HEAD STARTFACILITY NUMBER:
153801390
ADMINISTRATOR:CRISTINA MACHUCAFACILITY TYPE:
850
ADDRESS:8325 BUENA VISTA BLVD.TELEPHONE:
(661) 845-7726
CITY:LAMONTSTATE: CAZIP CODE:
93241
CAPACITY: 53TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/27/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Diana DavilaTIME COMPLETED:
10:45 AM
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On 07/27/2021 Licensing Program Analyst (LPA) Robert Gutierrez, conducted an unannounced Annual Required continuation Inspection for the preschool license. During the inspection on 07/15/2021 LPA was unable to obtain signatures. During todays inspection, LPA obtained signatures.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited.

SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Robert Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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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