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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210936
Report Date: 06/30/2020
Date Signed: 06/30/2020 05:18:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CIPRES FCC AKA LITTLE BUGS CHILDCAREFACILITY NUMBER:
406210936
ADMINISTRATOR:CINDY CIPRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 460-7057
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 13DATE:
06/30/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:CIndy CipresTIME COMPLETED:
04:00 PM
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On 6/30/2020, Licensing Program Analyst (LPA), Gigi Reyes conducted a Case Management inspection and met with Licensee, Cindy Cipres. LPA discussed the purpose of the inspection. Due to COVID-19 and Department of Public Health guidelines of social distancing the inspection was conducted via Zoom. There were 13 children, Licensee and an assistant present.

The Decision and Order CDSS No. 7919298010, No.CDSSNo. 7919298010B was provided and delivered to licensee on June 30, 2020. The Decision and Order stipulates, pursuant to Health and Safety Code section 1596.8897, Kiona Kupstas, AKA Kiona Marissa Kupstas is prohibited from employment in, presence in, and contact with clients of, any facility licensed by the Department, certified by a licensed foster family agency, or any resource family home and from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, for the remainder of Ms. Kupstas' life. The Decision and Order shall become effective May 11, 2020. It is ordered on May 1, 2020.

No deficiency was cited during today's visit.

Notice of Site Visit was issued
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2020
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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