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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426209205
Report Date: 07/25/2022
Date Signed: 07/25/2022 02:06:54 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/25/2022 02:06 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426209205
ADMINISTRATOR:MARIA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 332-3000
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 3DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Maria PerzTIME COMPLETED:
02:20 PM
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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.

Licensing Program Analyst (LPA) Martina Jimenez conducted an Annual Random inspection and met with Maria Perez, Licensee. There were 3 children present. The licensee stated the 3 children are licensee's own grand-children. LPA and licensee toured the home inside and out.

Licensee stated that she is not operating day care children. The last date licensee cared for children was on May 8, 2019.

Licensee completed LIC 9211 - request for inactive status during the inspection.

There were no deficiencies cites at this time. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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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