Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 11/04/2015
Date Signed 11/04/2015 10:49:00 AM

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:SIMONIAN FCC AKA HOPE FAMILY CHILD CAREFACILITY NUMBER:
406214343
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
11/04/2015
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Robin Rose SimonianTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Maria Mueller conducted a case management visit and met with licensee, Robin Simonian. LPA observed 6 children in the home. Licensee requested to increase the capacity of her license from 8 children to 14 children. The home was toured inside and outside. The day care area is located in the living room, dining room area and one bedroom used for napping. The home is clean and organized.

The backyard is completely fenced, LPA observed age appropriate toys, and garden area for children.
The fire extinguisher was purchased January 15, 2015. Carbon monoxide / smoke detector was observed in the hallway.

Licensee is current with CPR and First Aid expires January 11, 2016.
The fire clearance was granted October 30, 2015.


Today, the home meets Title 22 Division 12 requirements for a large license.

Effective date of large license is November 4, 2015.
SUPERVISOR'S NAME: Deborah AjaoTELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Maria MuellerTELEPHONE: (805) 729-8797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2015
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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