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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216619
Report Date: 08/02/2023
Date Signed: 08/02/2023 01:32:53 PM

Document Has Been Signed on 08/02/2023 01:32 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
406216619
ADMINISTRATOR:CARMEN FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 286-4209
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Carmen FloresTIME COMPLETED:
01:45 PM
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On this date, Licensing Program Analyst (LPA) Dixie Wright met with Licensee Carmen Flores for a follow up pre-licensing visit. This application is for a change of location, former location's license number is 406214142.

The Individuals that lived in the back studio building moved out July 28th, 2023, and there is nobody living in the studio. LPA toured the studio and noted it was empty and there were no items observed indicating anyone lives there. LPA observed all the tools locked in a shed outside. LPA observed rubber mats were installed under the swing set. Licensee will send proof of new residence for the individuals that formerly occupied the studio. The new location will meet licensing requirements once this is received. Licensee indicated she would like to be licensed at the new location on August 9th, 2023.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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