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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212317
Report Date: 10/07/2021
Date Signed: 10/07/2021 01:54:14 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:FERNANDO FAMILY CHILD CAREFACILITY NUMBER:
566212317
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 1DATE:
10/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Kumudu FernandoTIME COMPLETED:
02:05 PM
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On October 7, 2021 at 1:16 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Case Management inspection. LPA met with Licensee Kumudu Fernando and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There was one (1) child in care at the time of the inspection.

On August 30, 2021 licensee submitted an application to Community Care Licensing (CCL) for an increase in capacity. CCL requested a fire clearance inspection from Ventura County Fire Department (VCFD) on August 30, 2021. On September 23, 2021, CCL received an approved fire clearance from VCFD allowing the facility to become a large family child care. LPA conducted the annual inspection for the facility prior to conducting the increase inspection with no deficiencies cited.

Effective today October 7, 2021 facility is approved to be a Large Family Child Care with a maximum capacity of 14.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco PedrozaTELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
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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