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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216175
Report Date: 03/09/2023
Date Signed: 03/09/2023 05:06:25 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/09/2023 05:06 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:PENA FAMILY CHILD CAREFACILITY NUMBER:
426216175
ADMINISTRATOR:ANN M PENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 284-3213
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
03/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:TIME COMPLETED:
03:14 PM
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On March 9th 2023 at 3:03PP, Licensing Program Analyst (LPA) attempted an Annual/Random inspection. LPA parked on the street and knocked on the door. There was no answer. There were no sounds to indicate adults/children present at the time of the arrival. LPA knocked again and identified Department and no answer.

Attempted inspection concluded.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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