<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216500
Report Date: 02/06/2023
Date Signed: 02/06/2023 04:51:16 PM

Document Has Been Signed on 02/06/2023 04:51 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:SJOGREN FAMILY CHILD CAREFACILITY NUMBER:
406216500
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
02/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Amorita SjogenTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/6/23, Licensing Program Analyst (LPA) Elvin Baddley conducted a Case Management Inspection to determine if a Register Sex Offender (RSO, A1) is on site or is associated with this Family Child Care Home's address. LPA met with LIcensee Amorita Sjogen and explained the nature of the inspection. LPA toured the interior and exterior of the FCCH and notes 2 children are present.

Licensee informed LPA Licensee has no knowledge of A! residing at the residential location. Licensee also provided LPA a declaration ( LIC 855) with regard to the aforementioned.

LPA concluded the inspection and provided Licensee a copy a Notice of Site (LIC 9058). LPA informed Licensee to ensure the Notice of Site Visit is posted for 30 days or a civil penalty of $100 may apply. .
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1