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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215835
Report Date: 11/15/2019
Date Signed: 11/15/2019 03:30:44 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: 6DATE:
11/15/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Isa Emma ZamoraTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Michael Avila and Betzayra Cervantes made an unannounced visit for the purpose of conducting a Case Management inspection. LPA Avila and Cervantes met with Licensee Isa Zamora and discussed the nature and purpose of the visit. A tour of the home was conducted by LPAs. Licensee applied for a Large Family Child Care Home License. An inspection was conducted by the Oxnard Fire Department on 9/20/2019, however Licensee was required to complete repairs prior to approval. Licensee completed the repairs and a Fire Clearance was granted by the Oxnard Fire Department on 11/13/2019.

A License to operate as a Large Family Child Care Home is effective today 11/15/2019.

No deficiencies were issued during this unannounced inspection.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2019
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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