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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215940
Report Date: 12/27/2021
Date Signed: 12/27/2021 01:36:14 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:LEDEZMA FAMILY CHILD CAREFACILITY NUMBER:
566215940
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Irma LedezmaTIME COMPLETED:
01:50 PM
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On December 27, 2021 at 1:0 AM Licensing Program Analysts (LPAs) Laura Villanueva and Michael Mathew conducted a Case-Management-Licensee initiated inspection and met with Licensee, Irma Ledezma. LPAs informed Licensee of the purpose of the visit. Prior to inspection, LPA Villanueva asked pre screening questions related to COVID 19, Licensee's response indicates there are no COVID 19 exposures on site. LPAs toured the home inside and outside with Licensee. The main child care areas are kitchen, living room, and hall bathroom. Licensee is requesting a capacity increase from a small family child care license to a large child care license. Fire inspection and clearance was granted 12/15/21. LPA's conducted an annual random inspection and found no deficiencies. Large capacity license is granted effective today. LPA's provided information on capacity requirements for large license. Report was translated in Spanish.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Laura VillanuevaTELEPHONE: (805) 722-5138
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2021
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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