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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700623
Report Date: 10/18/2022
Date Signed: 10/18/2022 09:45:46 AM

Document Has Been Signed on 10/18/2022 09:45 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:BROWN FAMILY CHILD CAREFACILITY NUMBER:
197700623
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
10/18/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Natalie BrownTIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPA's) Justin Dorsey, met with Applicant, Natalie Brown for the purpose of conducting a Follow-Up Pre-Licensing inspection for a Small Family Day Care Home, a small family day care home may provide care for more than 6 children and up to and including 8 children, when a qualified assistant is present assisting with the children. This follow-up visit is to review corrections from the initial pre-licensing visit conducted by LPA Dorsey on 09/15/22.

LPA observed the following corrections:
1.) Mesh gate was installed around the homes pool.
2.) Carbon monoxide detector was placed in the homes detached garage.
3.) A cover was placed on the electrical outlet in the homes detached garage near the restroom.

During the visit LPA Dorsey reminded licensee that children shall not sleep or eat in the homes detached garage. Main care shall be conducted in the home.

An exit interview was conducted and a copy of this report was provided to applicant Natalie Brown.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Justin Dorsey
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2022
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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