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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406211893
Report Date: 03/17/2023
Date Signed: 03/21/2023 10:04:30 PM


Document Has Been Signed on 03/21/2023 10:04 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CANCHE FAMILY CHILD CAREFACILITY NUMBER:
406211893
ADMINISTRATOR:MARY CANCHEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 904-3030
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:14CENSUS: 3DATE:
03/17/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary Jane CancheTIME COMPLETED:
11:45 AM
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On March 17, 2023, Licensing Program Analysts (LPAs) Francisca Velazquez and Giovani Gonzalez conducted an unannounced Case Management inspection. LPAs met with licensee, Mary Jane Canche and discussed the purpose of the inspection. There were three grandchildren present at the time of the inspection.

The purpose for this inspection is to deliver the Accusation Exclusion Action CDSS No. 7922318001.

A copy of the Accusation Summary indicates the Departments intent of Exclusion Action against, Gabriel Canche. LPAs and Licensee toured the facility and note per licensee, Gabriel Canche has not lived in the Family Child Care Home (FCCH) since September of 2020. Per licensee, there is no contact with Gabriel Canche and licensee is not aware of Gabriel's current living address. Per licensee, Gabriel Canche lives with his mother and last known address is in Santa Maria, CA.

LPAs explained to Licensee that a copy of this Accusation will be provided to the parent/guardian of currently enrolled child by the next business day or immediately upon return and to the parent/guardian of newly enrolled child until the accusation is either dismissed or resolved through the administrative hearing or stipulated agreement. A signed Acknowledgement of Receipt of Accusation (LIC 9224), or other written statement, must be placed in the child's file for verification.

LPAs provided the Accusation and Acknowledgement of Receipt of Licensing Reports (LIC 9224).

No deficiency was cited today. A Notice of Site Visit was issued. Appeal Right were given.

Exit interview was conducted and report was reviewed with Licensee, Mary Jane Canche.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023
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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