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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014802
Report Date: 05/03/2022
Date Signed: 05/03/2022 04:25:43 PM

Document Has Been Signed on 05/03/2022 04:25 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROOLVINK FAMILY CHILD CAREFACILITY NUMBER:
198014802
ADMINISTRATOR:AIMEE ROOLVINKFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 914-3692
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Aimee RoolvinkTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cynthia Reyes conducted an unannounced 1 year annual inspection on this date. LPA met with Licensee Aimee Roolvink and a copy of the Entrance Checklist for Child Care homes form (LIC 126) was provided. Licensee stated her phone number has changed and was given new number. LPA observed a young woman who identified herself as the licensee assistant Millie Delgado. LPA observed that Millie is not fingerprint cleared and licensee stated she has only been working 3 days since her last assistant quit and thought she had a week to get her fingerprints done. LPA reviewed and obtained information from Millie driver license. Millie left the day care and understood she can not assist with the day care because she is not fingerprint cleared. Also in the home on this date was licensee husband John and her their underage daughters. Licensee stated she wishes to close her facility at this time. LPA advised a week notice to the children's parents should be provided. Licensee stated she will start to inform the parents of the children enrolled on this date that her official last day will be on Friday 05/06/2022. Licensee provided the LPA with a closure letter and her license.

4:13 PM Exit interview conducted and report was reviewed with Licensee, Aimee Roolvink and husband John.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2022
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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