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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216555
Report Date: 08/06/2024
Date Signed: 08/06/2024 10:15:41 AM

Document Has Been Signed on 08/06/2024 10:15 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:PINEDA-CORTEZ FCCHFACILITY NUMBER:
426216555
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Brenda Cortez PinedaTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On August 6, 2024, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Inspection for the purpose of performing a inspection. Case Management, Change of Capacity. LPA Jimenez met with Brenda Pineda-Cortez, licensee, Amelia Cortez-Pineda, licensee's mother. LPA discussed the purpose of the Inspection.

The licensee stated the FCCH is closed from August 2, 2024 through August 11, 2024, and will reopen on August 12, 2024. This inspection will continue on a later date. LPA provided the licensee LIC9149, for landlord's consent on change of capacity, during the inspection.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. A notice of site visit was given to applicant, 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 the Brenda Cortez-Pineda, licensee.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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