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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215837
Report Date: 03/13/2020
Date Signed: 03/13/2020 03:55:48 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:HALE FAMILY CHILD CAREFACILITY NUMBER:
426215837
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
03/13/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Megan HaleTIME COMPLETED:
04:00 PM
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An unannounced Case Management Inspection was conducted by LPA S. Mendoza-Ceja who met with Licensee Megan Hale who was providing care to four children of which two are her own children. Licensee had requested previously to use alternate rooms of the home due to water leak/broken pipe that had damaged the wood floor and wall. Licensee stated the kitchen floor has been replaced and the carpet in the day care room, including the living room was also replaced.

LPA also discussed the Exemption Process and the requirement to submit documents timely. LPA also reviewed the FCCH Addendum to Notification of Parents Rights (Regarding Exclusion).

No deficiencies were cited.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2020
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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