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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566214979
Report Date: 06/23/2022
Date Signed: 06/23/2022 12:34:49 PM

Document Has Been Signed on 06/23/2022 12:34 PM - It Cannot Be Edited

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:SEPULVEDA FCC AKA SHORTY BEAR DAY CAREFACILITY NUMBER:
566214979
ADMINISTRATOR:AMANDA SEPULVEDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 486-0354
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Amanda Sepulveda & Irma ReyesTIME COMPLETED:
12:45 PM
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On June 23, 2022, at 11:30 AM, Licensing Program Analyst (LPA) Laura Villanueva made an unannounced visit to conduct a Required - 1 Year Inspection. LPA met with licensees, Amanda Sepulveda and Irma Reyes and explained the purpose of the inspection. Prior to entering the facility, LPA conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. Licensees were caring for 4 children at the time of the inspection.

LPA continued with the annual inspection started 6/22/22. LPA had issues with laptop and had to end visit before completion. LPA reviewed LIC809 with Licensees, collected signatures, and provided copies.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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