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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566213717
Report Date: 09/01/2021
Date Signed: 09/01/2021 12:01:48 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:CDR - SIERRA LINDA HEAD STARTFACILITY NUMBER:
566213717
ADMINISTRATOR:SUZANNE GODINEZFACILITY TYPE:
850
ADDRESS:2201 JASMINE STREETTELEPHONE:
(805) 485-9800
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY:48CENSUS: 6DATE:
09/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Dina Elzahed TIME COMPLETED:
12:05 PM
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On September 1 2021, at 11:35AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an unannounced case management inspection to amend the licensing report dated for 08/25/2021 and obtain new signatures.

LPA met with Site Supervisor Dina Elzahed and the purpose of the inspection was discussed. Census was taken and ratio and capacity limitations of the license were found to be in compliance during today’s inspection.

Amended report was reviewed, signed, and a copy was provided to Site Supervisor.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 consecutive daysduring the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Appeal Rights were explained & provided.

Exit interview was conducted with Site Supervisor Dina Elzahed.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Betzayra CervantesTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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