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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215835
Report Date: 07/25/2019
Date Signed: 07/25/2019 02:22:18 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:ZAMORA FAMILY CHILD CAREFACILITY NUMBER:
566215835
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
07/25/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Isa Emma ZamoraTIME COMPLETED:
02:35 PM
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Licensing Program Analysts (LPA) Michael Avila conducted a licensee initiated case management inspection for change of facility location. Previous facility no. 566214232. LPA Avila met with Licensee Isa Emma Zamora and discussed the nature and purpose of the visit. LPA Avila toured the house with License.This home is a two story 4 bedroom house with an attached garage. The rear yard is fully enclosed with a gated fence. No bodies of water were observed on the property. Licensee states the upstairs bedrooms will be off-limits. Care of the children will be facilitated downstairs in the attached rear den, downstairs living room and kitchen/dining room. The day care area is located to the right as you walk in the front door. A fire extinguisher was observed in the home along with a carbon monoxide and smoke detector. Licensee states there are no firearms stored in the home. Control of property was verified via review of escrow documents. Licensee is current with first aid/CPR which will expire on 5/17/2020.

Change of location will be effective 7/29/2019.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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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