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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216201
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:35:56 PM

Document Has Been Signed on 01/27/2023 12:35 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:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
426216201
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
01/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Leticia LopezTIME COMPLETED:
12:37 PM
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On January 27th, 2023, at 11:42AM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Case Management inspection for the purposes of capacity increase. LPA advised licensee of the purpose of the visit and toured the home inside and out with the licensee. At the time of the inspection there was 1 child present (grandchild only) with licensee.

Licensee submitted an application to the Community Care Licensing (CCL) on 6/10/2022 requesting an increase in capacity to be licensed as a large Family Child Care Home (FCCH). This is a single story three (3) bedroom, two (2) bathroom home. Home consists of bedrooms, bathrooms, kitchen/dining room, living room, garage, and back yard.

On limit areas are identified as: living room, kitchen/dining room, and back yard.

Off limit area are identified as: all bedrooms, all bathrooms, and garage.

A fire clearance was approved by the Lompoc Fire Department on 9/12/2022. Licensee has completed all required licensing requirements for increase.

FCCH meets requirements of a large FCCH for an increase of capacity to fourteen (14) effective today 1/27/2023.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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