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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700066
Report Date: 06/29/2022
Date Signed: 06/30/2022 06:53:45 AM

Document Has Been Signed on 06/30/2022 06:53 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:ARELLANO FAMILY CHILD CAREFACILITY NUMBER:
157700066
ADMINISTRATOR:ROSA ARELLANOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 889-0681
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Rosa Arellano, ApplicantTIME COMPLETED:
03:19 PM
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 On 06/29/2022, at 1:40 p.m. Licensing Program Analysts (LPA) Esequiel Rodriguez made an announced inspection with Applicant, Rosa Arellano for the purpose of completing a required facility Pre-Licensing Inspection prior to licensure. On a previous inspection conducted on 06/27/2022 the LPA's computer did not worked properly.

During today's inspection the inspection was completed. Copy of this document, previous inspection report, Technical Assistance advisories notes, and notice of site visit were provided to Ms. Arellano and an exit Interview was conducted.
SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Esequiel Rodriguez
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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