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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217185
Report Date: 10/01/2024
Date Signed: 10/01/2024 03:01:30 PM

Document Has Been Signed on 10/01/2024 03:01 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:FARIAS FAMILY CHILD CAREFACILITY NUMBER:
426217185
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
10/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:22 PM
MET WITH:Martha Farias ManzoTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 10/01/2024 at 2:22 PM, Licensing Program Analyst (LPA), Martina Jimenez conducted a case management - other inspection for the purpose of obtaining an updated telephone number and reschedule the Change of Location inspection.

LPA met with Jose Cruz Farias, licensee's father. LPA advised Mr. Farias the purpose of this inspection. LPA observe two (2) children at the time of the inspection. Mr. Farias stated they are licensee's own children.

During the inspection Mr. Farias contacted the licensee to inform the licensee that LPA was in the home. LPA obtained from the licensee the updated telephone information and rescheduled the change of location inspection for 10/2/2024.


During today's inspection no deficiency as cited. Exit interview and report was reviewed with Jose Cruz Farias, licensee's father, licensee. Notice of site visit was provided and must remain posted for the next 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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