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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216547
Report Date: 05/23/2023
Date Signed: 05/25/2023 09:01:51 AM

Document Has Been Signed on 05/25/2023 09:01 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:LUNA FAMILY CHILD CARE HOMEFACILITY NUMBER:
426216547
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
05/23/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Amanda LunaTIME COMPLETED:
10:07 AM
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This is an amendment to correct report date issued 5/23/2023.

On May 23rd 2023, at 9:25 AM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a continued pre-licensing inspection. LPA met with applicant Amanda Luna. Present in the home was husband Daniel Luna – fingerprint cleared.

LPA toured the property and the follow corrections have been cleared:

  1. Perimeter fencing of the outdoor area.
  2. Removal of or locked storage of bathroom toxins and poisons.
  3. Placement of either gates or locks for kitchen and laundry room.

This home meets Title 22 Division 12 of a Small Family Child Care Home effective today 5/23/2023.

Exit interview conducted, copy provided.

Notice of Site Visit posted.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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