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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215188
Report Date: 10/10/2022
Date Signed: 10/10/2022 01:11:28 PM


Document Has Been Signed on 10/10/2022 01:11 PM - 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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
426215188
ADMINISTRATOR:ALEJANDRA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 287-0854
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 0DATE:
10/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Alejandra DiazTIME COMPLETED:
01:20 PM
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On October 10, 2022 @ 12:30 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Inspection for the purpose of performing an Annual Required inspection. LPA asked licensee Pre- Screening questions related to COVID-19. Licensee's responses to the Pre-screening questions suggest no COVID-19 exposure on site.

LPA Jimenez met with Alejandra Diaz, Licensee, and minor son. The purpose of the Inspection was discussed. The licensee stated is closed today, due to licensee had a medical emergency yesterday 10/09/2022. Licensee stated will reopen on 10/11/2022. The annual inspection will continue on a later date.

There were no deficiencies cites at this time. 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: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2022
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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