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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208696
Report Date: 12/22/2021
Date Signed: 12/22/2021 08:39:39 AM

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:NAVARRO FAMILY CHILD CAREFACILITY NUMBER:
426208696
ADMINISTRATOR:MARIA NAVARROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 345-1927
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 2DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Maria NavarroTIME COMPLETED:
08:50 AM
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 12/22/2021, at 7:45 AM Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management Inspection of the above mentioned Child Care Home (FCCH) to deliver an amended LIC 809 report for the inspection conducted on 12/17/2021. LPA met with Maria Navarro and reviewed the report. LPA amended the report, altering a potion of the deficiencies section. The report was reissued and signed.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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