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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213676
Report Date: 10/28/2021
Date Signed: 10/28/2021 02:29:36 PM

Document Has Been Signed on 10/28/2021 02:29 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:CAPSLO - CAMBRIA CHILDREN'S CENTERFACILITY NUMBER:
406213676
ADMINISTRATOR:A. RAMIREZ-BARRONFACILITY TYPE:
850
ADDRESS:1350 MAIN STREETTELEPHONE:
(805) 927-0830
CITY:CAMBRIASTATE: CAZIP CODE:
93428
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Angela RicoTIME COMPLETED:
02:30 PM
NARRATIVE
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On 10/28/21, at 1:30 PM Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Case Management Inspection of the abovementioned Child Care Center (CCC) to deliver an amended LIC 809 report.(Case Management). LPA met with Tala Romero, Site Supervisor of the CCC, and Angela Rico, Regional Manager of CAPSLO and reviewed the report. LPA amended the report, altering a potion of the narrative section. The report was reissued and signed.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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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