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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215243
Report Date: 05/22/2019
Date Signed: 05/22/2019 11:25:43 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:TENESACA FCC AKA UP IN THE TREE PRESCHOOLFACILITY NUMBER:
426215243
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
05/22/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Evelyn TenasacaTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Ruth Gull made an unannounced CASE MANAGEMENT inspection to the home regarding Licensee's request for increase in capacity. Met with Evelyn Tenesaca, Licensee and explained the purpose of the visit. LPA toured the home. There were 3 children present and an adult assistant. The fire clearance was granted on 05/17/19 for 14 children. LPA reviewed capacity requirements with Licensee.

The home is licensed for 14 children effective today, 05/22/19.

There were no deficiencies observed in areas evaluated.

Notice of Site Visit (LIC 9213) was posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2019
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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