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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215684
Report Date: 05/04/2022
Date Signed: 05/04/2022 03:10:49 PM


Document Has Been Signed on 05/04/2022 03:10 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:JONES FAMILY CHILD CAREFACILITY NUMBER:
406215684
ADMINISTRATOR:CAMERON JONESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 610-2744
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 5DATE:
05/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Cameron JonesTIME COMPLETED:
03:25 PM
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On May 4, 2022 at 2:30 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with licensee Cameron Jones and advised her the purpose of the inspection. Licensee provided LPA a tour of the facility. There were five (5) children in care at the time of the inspection.

On April 7, 2022, licensee contacted Community Care Licensing (CCL) to self report an incident regarding C1 possibly touching C2 in the vagina area. C2's mother observed that they had scratches in the area. When questioned, C2 advised their mother that C1 had scratched them. C2's mother contacted licensee and advised them of the incident.

LPA spoke with licensee about the incident. LPA conducted record reviews. A copy of the roster was requested and provided. Due to insufficient information available at this time, the above incident(s) need(s) further investigation.

No deficiencies were cited during today's visit.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2022
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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