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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216291
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:10:18 AM

Document Has Been Signed on 06/06/2023 11:10 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:IZA FCCHFACILITY NUMBER:
566216291
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Aurora IzaTIME COMPLETED:
11:25 AM
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On June 6, 2023, Licensing Program Analysts (LPAs) Susana Martinez and Daniel Venegas conducted an announced Pre-licensing inspection. LPA discussed the nature and purpose of the inspection. Licensee and LPA toured the facility inside and outside. There were no children in care at the time of the inspection.

As the inspection was being conducted, applicant disclosed that she is currently licensed in the Los Angeles County. LPA requested to see the license. License was issued in North Hollywood under license: 195700037. LPA contacted Lisa Clayton, LPA who issued the license on 2/28/23. Lisa states she was unaware that the licensee had an open application in the SBRO. LPA Martinez advised Lisa of pre-licensing inspection being conducted at the moment. Lisa asked to speak to the licensee, Lisa reminded licensee that in order to close out license in North Hollywood she needed to submit her original license back to their Regional Office. LPA asked licensee why she hadn't sent it in, Licensee stated she just hasn't. LPA advised licensee she must submit the original license back to the Regional Office.

Home does not meet Title 22 Regulations and is pending:
- Confirmation of License:195700037 closure.
- Heater in living-room to be completely screened off.
- Making the off-limits restroom/laundry room inaccessible to children.
- Regulatory Fire Extinguisher.

Exit interview conducted and report reviewed in Spanish with applicant Aurora Iza.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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