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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213506
Report Date: 03/26/2021
Date Signed: 03/26/2021 01:18:27 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:PERKINS FAMILY CHILD CAREFACILITY NUMBER:
406213506
ADMINISTRATOR:PERKINS, JUANETTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 460-6490
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 2DATE:
03/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Juanetta PerkinsTIME COMPLETED:
10:55 AM
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On 3/26/21 at 10:04am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Pre-Screen for COVID19 with Licensee's Assistant who was wearing a mask. Based on Assistant’s responses, LPA determined that it was appropriate to enter the home. LPA was invited by Assistant to enter the home; LPA was wearing a surgical mask. LPA explained to Assistant, that the purpose of the visit was to interview a child in care in regard to an incident which occurred at another licensed facility. Child (C1 on confidential names LIC811) was interviewed in the indoor activity area adjacent to the kitchen.

Licensee arrived at the Family Child Care (FCC) home. LPA completed the interview with C1, typed the report in the her vehicle and then returned to review the report with Licensee, Juanetta Perkins at 10:46am. The report will be emailed to Licensee today. Licensee voiced understanding that an email reply is required within 24 hours to confirm receipt of report and LIC811.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2021
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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