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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 367700393
Report Date: 10/16/2024
Date Signed: 10/16/2024 03:07:47 PM

Document Has Been Signed on 10/16/2024 03:07 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
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:REYES FAMILY CHILD CAREFACILITY NUMBER:
367700393
ADMINISTRATOR/
DIRECTOR:		ARTURO REYESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 200-9060
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:04 PM
MET WITH:Licensee Reyes- Licensee TIME VISIT/
INSPECTION COMPLETED:
03:20 PM
NARRATIVE
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On October 16, 2024, Licensing Program Analyst (LPA) Braddock conducted a case management inspection to the Reyes Family Child Care. Upon arrival, LPA met with licensee assistant (Iesha Bennett) who granted access. When LPA arrived to the facility, There were 6 children and 2 assistants. During the inspection visit, LPA observed a child sleeping in a bouncy seat inside the day care.


A Type B deficiency was issued during this visit. See 809 D for deficiency cited.

Exit interview was conducted and a copy of this report, Notice of Site Visit, and Appeals Rights were discussed and provided to the licensee at the facility. A Notice of Site visit was posted and must remain posted for 30 days. Removal of posting is subject to a $100
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Sherell Braddock
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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Document Has Been Signed on 10/16/2024 03:07 PM - It Cannot Be Edited


Created By: Sherell Braddock On 10/16/2024 at 02:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: REYES FAMILY CHILD CARE
FACILITY NUMBER: 367700393

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2024
Section Cited
CCR
102417(g)(10)

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102417(g)(10) A baby walker or bouncer shall not be kept or used on the premises of a child day care facility. This requirement was not met as evidenced by:
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Licensee will provide a declaration by POC date
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Based on observation and interview, LPA entered the home and observed a sleeping child in the bouncer. Licensee was informed that baby bouncy seats are not allowed in licenced facilities
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lady King
LICENSING EVALUATOR NAME:Sherell Braddock
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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