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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216475
Report Date: 06/03/2024
Date Signed: 06/12/2024 03:52:34 PM

Document Has Been Signed on 06/12/2024 03:52 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SIORDIA-DE GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
426216475
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 5CENSUS: 3DATE:
06/03/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Maria Siordia-De Gonzalez TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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THIS REPORT WAS AMENDED DUE TO REFLECT CHANGE OF CAPACITY.

On June 3, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management - Change of Capacity inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with Licensee Maria Siordia-De Gonzalez and informed them the purpose of the inspection. At the time of the inspection 3 children were in care.

LPA in the company of the Licensee toured the FCCH. LPA observed the FCCH’s interior and exterior to be free of hazardous materials that could pose a danger to children in care.

LPA observed a fire extinguisher that satisfies regulation (3A40BC) that was purchased 12/20/2023. LPA reminded Licensee the responsibility to service or purchase a regulation fire extinguisher annually. LPA reviewed Licensee’s Mandated Reporter Training certificate which was completed 5/7/2024 . LPA reviewed Licensee’s Pediatric CPR/First Aid which was completed 1/29/2023. LPA observed a smoke detector and a carbon monoxide detector which was tested and found to be operational at 10:30AM.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 5/23/2024.

The home meets Title 22 of CCR requirements for a Large Family Child Care license. The effective date of license is today 6/3/2024.

Exit interview was conducted and Notice of Site visit was given.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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