<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215642
Report Date: 09/30/2021
Date Signed: 09/30/2021 02:57:59 PM

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:LOPEZ FCC AKA SHOOTING STARS CHILD CAREFACILITY NUMBER:
426215642
ADMINISTRATOR:ADRIANA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 863-3292
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 3DATE:
09/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Adriana LopezTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/30/2021, Licensing Program Analyst conducted an unannounced Case Management Inspection to the above mentioned Family Child Care Home (FCCH) LPA asked pre screening questions prior to inspections, Licensee's responses indicate there are no COVID 19 exposure on site. Upon arrival at FCCH, Licensee was out picking up children from school. Licensee came after 15 minutes.

LPA discussed the purpose of the inspection to obtain signature and hand deliver the Facility Evaluation Report (LIC 809) for Required -1 Year inspection conducted on 9/29/2021. LPA observed 3 children present at day care.

No deficiency was cited today.

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: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1