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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700036
Report Date: 07/21/2022
Date Signed: 07/21/2022 02:53:28 PM

Document Has Been Signed on 07/21/2022 02:53 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:ARRIETA FAMILY CHILD CAREFACILITY NUMBER:
197700036
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
07/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:34 PM
MET WITH:Martha Arrieta & Assistant #1TIME COMPLETED:
03:07 PM
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On 07/21/22 Licensing Program Analyst (LPA) Justin Dorsey conducted an inspection at Arrieta FCC. The purpose of the inspection was a Plan of Correction visit to review the deficiency cited on 07/11/22. LPA met with Licensee Arrieta and Assistant #1 and toured the facility.

The following was observed:
1.) LPA Dorsey observed the blow up pool has been deflated and placed on an off-limits area of the homes backyard.

Exit interview conducted a copy of this report, Notice of Site Inspection and Deficiency Clearance Letter was left with Assistant #1.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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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