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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215847
Report Date: 01/12/2023
Date Signed: 01/12/2023 02:21:44 PM

Document Has Been Signed on 01/12/2023 02:21 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:ALVARADO FCC AKA NALLTA'S FAMILY CHILDCAREFACILITY NUMBER:
426215847
ADMINISTRATOR:DIANA ALVARADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 363-5421
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Diana AlvaradoTIME COMPLETED:
02:25 PM
NARRATIVE
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On 1/12/2023, at 12:30PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection at the above Family Child Care Home (FCCH).
LPA asked pre screening questions related to COVID-19 and licensee's responses indicate there are no COVID-19 exposure on site. LPA met with Licensee Diana Alvarado and discussed the nature of the inspection. LPA observed 8 children present at the FCCH.

California Department of Social Services (CDSS) received a Report stating that on August 16, 2022, Adult # 1, a resident at the FCCH was arrested due to inappropriate relationship with a minor which was/is inimical to health, morals and safety of the minor victim. Adult # 1 was eventually released.

In addition, Licensee failed to report the arrest incident of Adult #1 to CDSS -Community Care Licensing.

During the inspection, LPA asked Licensee the number of adults that live in the home, Licensee responded there are five (5) adults in the home as opposed to the current Personnel Summary Report and Guardian Employee Roster which list only four (4) adults.
Licensee stated that adult child, Nathaniel Alvarado recently moved in to the home on or about January 4, 2023 and has not obtained the criminal record clearance.


Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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Document Has Been Signed on 01/12/2023 02:21 PM - It Cannot Be Edited


Created By: Gigi Reyes On 01/12/2023 at 10:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ALVARADO FCC AKA NALLTA'S FAMILY CHILDCARE
FACILITY NUMBER: 426215847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2023
Section Cited
CCR
102402(a)(3)

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102402 Revocation or Suspension of a License or Registration
(a) The Department shall have the authority to suspend ....
(3) Conduct in the operation or maintenance of a family day care home which is inimical...This requirement is not met as evidenced by:
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Licensee agreed to submit a written plan of correction to Community Care Licensing (CCL) no later than 1/13/2023.
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Based on documentation obtained, on or around August 16, 2022, Adult #1 was arrested due to inappropriate relationship with a minor. This poses an immediate risk to health and safety of children in care.
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Type A
01/13/2023
Section Cited
CCR102370(d)(1)

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102370 Criminal Record Clearance
(d) All individuals subject to a criminal record review ... shall prior to working, residing, or volunteering in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department or.
This requirment is no met as evidenced by:
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Licensee agreed to submit a written plan of correction to CCL no later than 1/13/2023.
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Based on review of Facility Roster and Interview with Licensee, Nathaniel Alvarado moved in to the home on or about 1/4/2023 without obtaining a criminal record clearance prior to residing in the home. This poses an immediate risk to health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/12/2023 02:21 PM - It Cannot Be Edited


Created By: Gigi Reyes On 01/12/2023 at 10:16 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: ALVARADO FCC AKA NALLTA'S FAMILY CHILDCARE
FACILITY NUMBER: 426215847

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2023
Section Cited
CCR
102416.2(b)(3)(C)

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(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. Any unusual incident or child absence that threatens the physical or emotional health or safety of any child." This requirement is not met as evidenced by:
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Licensee agreed to submit a plan of correction to CCL no later 1/20/2023.
[email protected]
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Based on the report obtained, on August 16, 2022, Adult # 1 was arrested by law enforcement. Licensee failed to report the incident which poses a potential risk to health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ALVARADO FCC AKA NALLTA'S FAMILY CHILDCARE
FACILITY NUMBER: 426215847
VISIT DATE: 01/12/2023
NARRATIVE
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The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited. A civil penalty of $500.00 was assessed.

LPA Reyes informed licensee, Diana Alvarado that this report dated January 12, 2023 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Reyes informed the licensee to provide a copy of this licensing report dated January 12, 2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification

LPA provided Licensee copies of the California Code of Regulations cited during the inspection.

Notice of Site visit was issued. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Diana Alavarado. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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