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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700045
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:14:03 PM

Document Has Been Signed on 07/07/2022 03:14 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:HANEY FAMILY CHILD CAREFACILITY NUMBER:
367700045
ADMINISTRATOR:HANEY, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 910-3573
CITY:TWENTYNINE PALMSSTATE: CAZIP CODE:
92277
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Licensee Cassandra Haney TIME COMPLETED:
03:20 PM
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On July 7, 2022 at 03:04pm Licensing Program Analyst (LPA) Kendal Zirbes met with Licensee, Cassandra Haney. The purpose of the inspection was to conduct a case management inspection to verify the Licensee is not operating a Family Child Care and ensure all required postings are present. Present at the time of inspection were two adults and zero children.

During this inspection, LPA observed the LIC 9031 sign posted on the front door. There is no evidence of care being provided in violation of the order.

Licensee’s signature on this form acknowledges receipt of this document.



Exit interview conducted: A copy of this report, appeal rights were emailed to the licensee.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Kendal Zirbes
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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