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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700475
Report Date: 04/22/2022
Date Signed: 04/22/2022 12:08:06 PM

Document Has Been Signed on 04/22/2022 12:08 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:SERRANO FAMILY CHILD CAREFACILITY NUMBER:
197700475
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
04/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Edna SerranoTIME COMPLETED:
12:22 PM
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Licensing Program Analysts (LPA's) Justin Dorsey and Justeene Tamayo conducted a Case Management- Plan of Correction (POC) in person inspection at the above facility to verify Adult #1 is not at the facility. Upon arrival LPA was greeted by licensee, Edna Serrano.

During today's inspection LPA observed 4 children in care with the licensee. LPA did not observe uncleared adults at the facility today. POC has been cleared.

The licensee was informed the presence of any adults in the home without Criminal Record Clearance or Exemption and not associated to facility will be cited and civil penalty assessed for $100 per day. Licensee stated Adult #1 left the facility 04/14/22, per licensee Adult #1 will not return to the home while daycare children are present before being fingerprint cleared.

An exit interview was conducted, a copy of this Report, Appeal Rights, and Notice of Site Visit were provided to licensee Edna Serrano.

SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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