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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213704
Report Date: 09/27/2021
Date Signed: 09/27/2021 11:33:37 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:CAC - OAK VALLEY CENTERFACILITY NUMBER:
426213704
ADMINISTRATOR:VERONICA RUBIOFACILITY TYPE:
850
ADDRESS:595 2ND STREET, #109TELEPHONE:
(805) 688-6992
CITY:BUELLTONSTATE: CAZIP CODE:
93427
CAPACITY:22CENSUS: 10DATE:
09/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Veronica RubioTIME COMPLETED:
11:35 AM
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On 9/27/2020 @ 10:50 AM Licensing Program Analyst conducted an unannounced Case Management Inspection to the above mention Child Care Center. LPA asked pre screening questions prior to inspections, Site Supervisor's responses indicate there are no COVID 19 exposure on site. LPA discussed the purpose of the inspection to obtain signature and hand deliver the amended LIC 809 Report conducted on 9/21/2021. Amendment of the report was to correct the room no. from 403 to 109.

During today's inspection, LPA observed 10 day care children and 3 teachers including the Site Supervisor.

No deficiency was cited.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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