Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215157
Report Date: 10/20/2016
Date Signed: 10/20/2016 12:36:30 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:MORENO FAMILY CHILD CAREFACILITY NUMBER:
426215157
ADMINISTRATOR:EMILY ANNE MORENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 736-3247
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 2DATE:
10/20/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Emily MorenoTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Ruth Gull made an unannounced CASE MANAGEMENT visit to the home in order to inspect new room additions. Met with Emily Moreno, Licensee and explained the purpose of the visit.There were 2 children present. A tour of the home was made both inside and outside. Licensee has added 2 bedrooms, 1 full bathroom, a 1/2 bathroom in one of the new bedrooms, a laundry room and the kitchen was expanded. The 2 new bedrooms, bathroom and laundry room will be off-limits/gated. LPA reviewed the completed city permit. Licensee states that she will continue to use the front yard for the day care. There are age appropriate toys/equipment. Licensee is reminded that the children should be physically and visually supervised at all times when in the front yard as it is not completely enclosed by a fence.

There were no deficiencies cited during today's visit.

The LIC 9213 (Notice of Site Visit) was posted during today's visit.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2016
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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