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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
566215336
Report Date:
10/11/2024
Date Signed:
10/11/2024 10:07:07 AM
Document Has Been Signed on
10/11/2024 10:07 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO
,
6500 HOLLISTER AVE., SUITE 200
GOLETA
,
CA
93117
FACILITY NAME:
FUSD - SAN CAYETANO PRE SCHOOL
FACILITY NUMBER:
566215336
ADMINISTRATOR/
DIRECTOR:
LORENA RAMOS
FACILITY TYPE:
850
ADDRESS:
514 MOUNTAIN VIEW ST.
TELEPHONE:
(805) 524-6040
CITY:
FILLMORE
STATE:
CA
ZIP CODE:
93015
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
24
CENSUS:
DATE:
10/11/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:
TIME VISIT/
INSPECTION COMPLETED:
09:57 AM
NARRATIVE
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On 10/11/24 LPA Veronica Diaz tried to conduct a required 3 year annual. LPA was informed by a maintenance worker that Fillmore Unified School District is on Fall break and should resume next week.
SUPERVISORS NAME
:
Lissete Gonzalez
LICENSING EVALUATOR NAME
:
Veronica Diaz
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2024
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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