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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
426212147
Report Date:
05/21/2019
Date Signed:
05/22/2019 10:45:31 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:
ADAM FAMILY CHILD CARE
FACILITY NUMBER:
426212147
ADMINISTRATOR:
LISA ADAM
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(805) 354-8281
CITY:
SANTA MARIA
STATE:
CA
ZIP CODE:
93455
CAPACITY:
14
CENSUS:
DATE:
05/21/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:50 PM
MET WITH:
TIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management and met with Licensee Ms. Lisa Adam. The purpose of the visit was discussed. LPA hand delivered the Facility Evaluation Report from 5/20/2019 Case Management Inspection. The report was not generated yesterday due to computer malfunction.
SUPERVISOR'S NAME:
Maria Mueller
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Gigi Reyes
TELEPHONE:
(805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE:
05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/21/2019
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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