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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566212414
Report Date:
06/26/2019
Date Signed:
06/26/2019 01:16:28 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:
CDI - HUENEME ELEMENTARY
FACILITY NUMBER:
566212414
ADMINISTRATOR:
AMBAR LOPEZ
FACILITY TYPE:
850
ADDRESS:
354 NORTH 3RD ST.
TELEPHONE:
(805) 488-3569
CITY:
PORT HUENEME
STATE:
CA
ZIP CODE:
93041
CAPACITY:
24
CENSUS:
0
DATE:
06/26/2019
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Maria Landeros
TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst Michael Avila made an unannounced visit for the purpose of conducting an Annual Random inspection. LPA Avila met with Maria Landeros who allowed LPA Avila entry onto the school campus. LPA walked to room 20 and noted the room was empty. LPA will need to conduct a follow visit at another time.
SUPERVISOR'S NAME:
George Mingle
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Michael Avila
TELEPHONE:
(805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE:
06/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/26/2019
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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