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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212147
Report Date: 06/04/2019
Date Signed: 06/04/2019 03:59:46 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:ADAM FAMILY CHILD CAREFACILITY NUMBER:
426212147
ADMINISTRATOR:LISA ADAMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 354-8281
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 12DATE:
06/04/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Lisa AdamTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Plan of Correction Inspection and met with Licensee, Ms. Lisa Adam and Assistant. The purpose of the visit was discussed. There were 12 children present, 2 being infants.

The following deficiencies cited during a case management inspection on 5/20/2019 have been cleared:

102416.5(d)(2) Staffing Ratio and Capacity: There were 12 children present under the supervision of licensee and assistant.

102370(d)(2) Criminal Record Clearance The assistant's, criminal record clearance has been transferred to this Family Child Care Home Facility.

102417(g)(10) Operations of a Family Child Care Home. The baby walker is no longer on the premises of day care home. Licensee stated it was returned to parent on 5/20/2019.

No deficiencies cited today.

LPA observed Licensee posted the Notice of Site Visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019
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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