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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214475
Report Date: 11/15/2022
Date Signed: 11/15/2022 10:02:36 AM


Document Has Been Signed on 11/15/2022 10:02 AM - 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:LOMPOC YMCA-MIGUELITO SCHOOL SITEFACILITY NUMBER:
426214475
ADMINISTRATOR:STEPHANIE SAUCEDOFACILITY TYPE:
840
ADDRESS:1600 WEST OLIVE AVENUETELEPHONE:
(805) 757-5038
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:50CENSUS: 0DATE:
11/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Molly ShaddockTIME COMPLETED:
09:48 AM
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On November 15th, 2022 at 11:15AM, Licensing Program Analyst (LPA) arrived at facility for the purposes of a Case Management Lead Inspection. Upon arrival met with Dean of school Molly Shaddock at Administrative Assistant Amy Jones. Both stated Administrator for facility, Stephanie Saucedo is not present and neither are children. Stated school aged day care center operates solely from 7:15am-8:15am and again from 2:00pm-6:00pm. LPA called Ms. Saucedo at number listed with Community Care Licensing Division (CCLD) 805-757-5038 and was prompted as not a working number. Dean provided LPA with alternate number for YMCA at 805-736-3483 X3034 and X3032. No answer for either lines. LPA left message for Ms. Saucedo to contact LPA and provided direct number.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose BreaultTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2022
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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