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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566206538
Report Date: 11/06/2019
Date Signed: 11/06/2019 11:47:32 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:TELLEZ MAYA FAMILY CHILD CAREFACILITY NUMBER:
566206538
ADMINISTRATOR:TELLEZ, ELIA MAYAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 525-2370
CITY:SANTA PAULASTATE: CAZIP CODE:
93060
CAPACITY:14CENSUS: 1DATE:
11/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elia Maya TellezTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with licensee Elia Maya Tellez and advised her the purpose of the inspection. Together LPA and licensee toured the home inside and out. Licensee had one child in care at the time of the inspection.

LPA advised licensee that Community Care Licensing (CCL) has been trying to get in contact with licensee to check on her status with the recent fire in the area. Licensee stated that she is doing well and safe. She still is providing care to children at her facility. Her phone has been down recently. Service technicians will be out to fix her phone on Friday November 08, 2019. Licensee provided LPA with her cellular phone to contact her.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019
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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