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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216374
Report Date: 09/20/2022
Date Signed: 09/20/2022 11:44:13 AM

Document Has Been Signed on 09/20/2022 11:44 AM - 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:KOL FAMILY CHILD CAREFACILITY NUMBER:
426216374
ADMINISTRATOR:BOTTA KOLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 242-2628
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/20/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Botta KolTIME COMPLETED:
11:30 AM
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On September 20th, 2022 at 11:00am Licensing Program Manager (LPM) Ana Tolentino and Licensing Program Analyst (LPA) Rosie Breault met with Applicant Botta Kol and Licensee Alexandra Camacaris (via Zoom) under the request of the Department for an in - office meeting at the Santa Barbara Regional Office. The purpose of the meeting is to review and discuss Title 22 Regulations, prior to licensure.
In response to these discussions, licensee and applicant have agreed to the following:

· "Licensee" means an adult licensed to operate a Family Day Care Home and who is primarily involved in providing care for the children during the hours that the home provides care.

· “Licensee” shall be present in the home and shall ensure that children in care are supervised at all times. When circumstances require the licensee to be temporarily absent from the home, the licensee shall arrange for a substitute adult to care for and supervise the children during his/her absence. Temporary absences shall not exceed 20 percent of the hours that the facility is providing care per day.

CONTINUED ON LIC809C


SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KOL FAMILY CHILD CARE
FACILITY NUMBER: 426216374
VISIT DATE: 09/20/2022
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· Licensee shall ensure children are supervised at all times. Licensee shall ensure that staffing ratio will be met at all times. Licensee will not exceed licensed capacity at any time.

· Licensee shall ensure children are provided safe and healthful environment.

· Licensee and future Licensee shall operate in compliance Title 22, Division 12 Family Child Care Home Regulations at all times.

Applicant and licensee acknowledge and understand the purpose of the office meeting. Applicant and licensee were explained the requirements to operate a family childcare home. Applicant and licensee's signatures at the bottom of this report acknowledges they received the reports and their rights.

Further references and resources can be found at: https://cdss.ca.gov/
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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