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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216504
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:31:57 PM

Document Has Been Signed on 08/07/2024 03:31 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:CARMONA FAMILY CHILD CAREFACILITY NUMBER:
426216504
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/07/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Flor CarmonaTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On August 7, 2024, at 10:30 AM, Licensing Program Analysts (LPAs) Gigi Reyes and Shane Loftus conducted an unannounced Case Management inspection. LPAs met with licensee, Flor Carmona and discussed the purpose of the inspection. LPAs observed 5 children under the care of the Licensee.

During today's inspection, LPAs delivered and discussed with Licensee the CDSS No. 7923257014-B Stipulation and Waiver; and Order which was ordered on February 1, 2024 and became effective on February 26, 2024.

The Order states that:
Family Child Care Home (FCCH) License and Licensee is under probation for two (2) years from the date the license is issued, (2/26/2024). During this period, the licensee agrees to operate the Family Child Care Home ( FCCH) in strict compliance with regulations and statues governing the operation of a FCCH. During this period of probation, the Department in its sole discretion may conduct unannounced site visits for the purpose of determining whether there is full compliance with regulations and statutes governing the operations of a FCCH .

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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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: CARMONA FAMILY CHILD CARE
FACILITY NUMBER: 426216504
VISIT DATE: 08/07/2024
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In addition, the licensee shall ensure that all individuals prior to working, residing or volunteering in the FCCH shall obtain a criminal record clearance or exemption. The licensee shall maintain current personnel records of each employee at the FCCH and ensure that all employees have current Adult and Pediatric CPR and First Aid training on file and all other required training certificates on file. Licensee shall ensure that children's records are complete.

During today's inspection, no deficiency was cited.

A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Licensee, Flor Carmona.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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