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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216160
Report Date: 11/16/2022
Date Signed: 11/16/2022 12:12:11 PM

Document Has Been Signed on 11/16/2022 12:12 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426216160
ADMINISTRATOR:MARYPAZ PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 863-3416
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Marypaz PerezTIME COMPLETED:
10:20 AM
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On November 16, 2022 at 9:40 AM, Licensing Program Analysts (LPAs) Francisca Velazquez and Elvin Baddley made an unannounced Case Management inspection at the Family Child Care Home (FCCH) for the purpose of ensuring Silvia Escobar is not in the premises. LPAs note that eight (8) children were present being cared by Licensee and two (2) assistants, Norma Romo and Dulce Escobar.

LPAs in he company of the Licensee toured the interior and exterior of the premises. LPAs note that during this inspection Silvia Escobar was not present.

Licensee stated understanding that Silvia Escobar can not be in the FCCH.

Notice of Site visit was given.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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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