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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213750
Report Date: 06/21/2019
Date Signed: 06/21/2019 09:55:25 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:LA PURISIMA CONCEPCION LITTLE SAINTS PRESCHOOLFACILITY NUMBER:
426213750
ADMINISTRATOR:TERESE MUNOZ-HILLFACILITY TYPE:
850
ADDRESS:219 W. OLIVE AVENUETELEPHONE:
(805) 736-6210
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:87CENSUS: 42DATE:
06/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Terese Munoz-HillTIME COMPLETED:
10:00 AM
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A case management inspection was conducted by Licensing Program Analyst (LPA) S. Mendoza-Ceja who met with Director Terese Munoz-Hill. LPA discussed the purpose of the inspection and advised the 02/08/2019, Case Management Report was incorrectly assessed and is being amended to reflect the correct amount of $500.00.


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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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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