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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209205
Report Date: 05/27/2020
Date Signed: 05/29/2020 12:24:10 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426209205
ADMINISTRATOR:MARIA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 332-3000
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 0DATE:
05/27/2020
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria PerezTIME COMPLETED:
11:30 AM
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This report was amended to include Emergency Resources/Disaster contact information.
On 5/27/20 at 11:00am, Licensing Program Analyst (LPA) Ruth Gull conducted an announced tele-video CASE MANAGEMENT visit via Facetime (due to the COVID-19 State of Emergency). LPA Gull met with Maria Perez, Licensee to discuss the fire which destroyed the home on Saturday 5/09/20. Licensee's adult daughter was also present and provided Spanish translation. Licensee had self-reported the incident on 5/11/20. There were no children in attendance at the time of the fire. Licensee states that she has been providing child care continuously through the COVID-19 State of Emergency and states that she had been providing care for 4 children prior to the fire (through Children's Resource and Referral of Santa Barbara County). LPA requested that Licensee submit a Children Roster to LPA.
Licensee states that she is currently not providing child care but that she will be submitting a request for an Emergency Temporary Relocation Waiver to be used until her home is ready for occupancy.

LPA Gull provided Licensee with emergency resources contact information for Taundra Pitchford, Manager - Early Care and Education, Santa Barbara County Education Office and Jacqui Banta, Chief Operating Officer, Children's Resource and Referral of Santa Barbara County.
LPA Gull also provided Licensee with the following Disaster links:
Legal assistance: Public Counsel http://www.publiccounsel.org/
Unemployment: Calfresh https://www.edd.ca.gov/about_edd/coronavirus-2019.htm
Guide to Disaster Assistance Services for Californians https://wildfirerecovery.caloes.ca.gov/wp-content/uploads/sites/7/2017/10/DisasterAssistanceGuideforCaliforniansFinal.pdf

Exit interview was conducted with Licensee Perez via tele-inspection. This report will be e-mailed to Licensee Perez via email with a read receipt or confirmation of receipt of email, which will act as the Licensee's signature.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2020
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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