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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406211893
Report Date: 05/26/2023
Date Signed: 05/26/2023 05:04:23 PM

Document Has Been Signed on 05/26/2023 05:04 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:CANCHE FAMILY CHILD CAREFACILITY NUMBER:
406211893
ADMINISTRATOR:MARY CANCHEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 904-3030
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/26/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Mary CancheTIME COMPLETED:
05:15 PM
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On 5/26/23, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management inspection to deliver Decision and Order- CDSS No. 7922318001 in the matter of Gabriel Canche. LPA met with Licensee, Mary Jane Canche and explained the purpose of the inspection. LPA notes five children (biological) are in care at the time of the inspection.

The Decision and Order details the exclusion of Gabriel Canche ordered 5/26/23, effective 6/5/23. Further, the Decision and Order notes Gabriel Canche ability to request to set aside default. The Licensee was provided a copy of the aforementioned.

LPA, toured the facility in the company of the Licensee. LPA did not observed Gabriel Canche on site. Licensee indicated Gabriel Canche has not lived in the Family Child Care Home since September of 2020 and Licensee has no contact with Gabriel Canche.

No deficiency was cited today. A Notice of Site Visit (LIC 9213) was issued and must be posted for 30 days or a civil penalty may apply. Appeal Right (LIC 9058) were given.

Exit interview was conducted and report was reviewed with Licensee, Mary Jane Canche.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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