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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700049
Report Date: 02/24/2022
Date Signed: 02/24/2022 10:13:56 AM

Document Has Been Signed on 02/24/2022 10:13 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:IRRA FAMILY CHILD CAREFACILITY NUMBER:
367700049
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
02/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:IRRA AURORA Licensee


TIME COMPLETED:
10:20 AM
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Licensing Program Analyst Babatunde Ibitoye met with licensee to deliver Annual report. LPA was unable to print report on 2-23-2022 and return to provide report to licensee.
During the time of the visit, LPA observed 2 children in care along with licensee spouse that was present.

LPA provided copy of site visit and 809 reports date 2-23-2022.

Exit Interview conducted and report was reviewed with the licensee IRRA AURORA
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Babatunde Ibitoye
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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