Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212781
Report Date: 10/18/2018
Date Signed: 10/18/2018 03:07:46 PM

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:MOROS FCC AKA LA CASITA CHILDCAREFACILITY NUMBER:
426212781
ADMINISTRATOR:PATRICIA MOROSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 566-0962
CITY:CARPINTERIASTATE: CAZIP CODE:
93013
CAPACITY:14CENSUS: 11DATE:
10/18/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Patricia MorosTIME COMPLETED:
03:15 PM
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A case management inspection was conducted by LPA S. Mendoza-Ceja who met with Licensee Patricia Moros to inspect the pool area. LPA inspected the pool and observed the pool to be secured. Licensee stated, she had all the safety pins replaced on the pool cover and also obtained a new key to lock the cover.
Licensee stated she also purchased extra pins for the pool in case they break.

LPA observed the "Notice of Site Visit" posted.


FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0412
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132 FAX 685-1820
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2018
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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