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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700816
Report Date: 05/10/2024
Date Signed: 05/10/2024 12:55:07 PM

Document Has Been Signed on 05/10/2024 12:55 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
197700816
ADMINISTRATOR/
DIRECTOR:		ALYSSA GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 941-7855
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Alyssa Garcia, Licensee TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 05/10/2024, Licensing Program Analysts (LPAs) Justeene Tamayo and Annelise Villa conducted a Case Management inspection to ensure RSO Anthony R. Anderson DOB:10/22/1954 is not residing at this facility home address. RSO mail notification was received at the Palmdale Regional office. There were 9 preschool children present, along with assistant #1.

LPAs met with Licensee Alyssa Garcia who stated RSO does not live at this address and does not know the individual. Per licensee, the house was previously vacant and does not know the previous owners/tenants.

All adults residing in the home is fingerprint-cleared and associated to the facility.

An exit interview was conducted, appeal rights, notice of site visit and copy not this report was provided to licensee.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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