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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215866
Report Date: 11/17/2022
Date Signed: 11/17/2022 12:40:28 PM

Document Has Been Signed on 11/17/2022 12:40 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:CORREA FAMILY CHILD CAREFACILITY NUMBER:
426215866
ADMINISTRATOR:ESPERANZA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-1854
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Esperanza CorreaTIME COMPLETED:
01:00 PM
NARRATIVE
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On November 17, 2022, Licensing Program Analysts (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Esperanza Correa, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The home's uses one (1) bedroom, one (1) bathroom, living room, dining room and outdoor yard are used for childcare services. Meanwhile, the kitchen, entire second floor, laundry room and garage are inaccessible to children in care. LPA notes, ten (10) children present being cared by Licensee and two (2) assistants, Esperanza Correa (Licensee’s parent) and Vishnu Garcia.

LPA observed children in the living room and dining area. The home was clean and orderly. There is plenty of ventilation to afford the children comfort. LPA observed a fireplace in the living room that is not secured and inaccessible to children in care. Licensee agrees to add safety latch to ensure that children do not have access to the fireplace. LPA observed sharps are stored in an elevated cabinet in the kitchen. LPA observed medication in another elevated cabinet in the kitchen. LPA observed cleaning compounds under the sink of the kitchen and in the laundry room, both areas are inaccessible to children in care. Toys, furniture, and equipment within the FCCH are age appropriate. LPA note that this is a two (2) story home, LPA observed gate securing the stairway. LPA also observed two (2) baby gates making the kitchen area inaccessible.

Required forms are predominantly posted on the wall. LPA observed no LIC610- Emergency disaster plan. Licensee stated that she was updating her emergency disaster plan and forgot it at Licensee’s child’s home. LPA notes there is no emergency disaster plan in the FCCH to review. LPA observed a combination smoke and carbon monoxide detectors in the FCCH that was tested at 9:50 AM and found to be operable. Likewise, the home has a regulation fire extinguisher which was purchased on 10/8/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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 11/17/2022 12:40 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 11/17/2022 at 11:36 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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in that the fire place in the living room has a screen but it is not secured to prevent access by children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Licensee will ensure that fireplace is secured and children do not have access to fireplace. Licensee will submit proof via email to [email protected] by 11/24/2022.
Type B
Section Cited
CCR
102417(g)(9)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in [that the facility does not have an emergency disaster plan readily available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2022
Plan of Correction
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Licensee agrees to create an emergency disaster plan and have it readily available for review. Licensee will submit proof via email to [email protected] by 11/24/2022.
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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 11/17/2022 12:40 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 11/17/2022 at 11:36 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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Esperanza Correa (Licensee's parent) and Vishnu Garcia do not have Mandated Reporter training certifcate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Licensee agrees to have both assistant complete Mandated Reporter training and submit proof of completion. Licensee will submit proof via email to [email protected] by 11/24/2022.
Type B
Section Cited
CCR
102416.1(a)(6)
Personnel Records
(a) Personnel records shall be maintained on each employee and shall contain the following information: (6) Documentation of completion of training on preventative health practices as required by Section 102416(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that there was no personnel file for Esperanza Correz (Licensee's parent) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Licensee agrees to create a personnel file for Esperanza Correz (LIcensee's parent) and submit proof to the Department. Licensee will submit proof via email to [email protected] by 11/24/2022.
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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/17/2022 12:40 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 11/17/2022 at 11:36 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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that out of the ten (10) children present, five (5) were not documented in the facility roster which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Licensee agrees to update and keep the facility roster current at all times. Licensee will submit proof via email to [email protected] by 11/24/2022.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that infant 15 mintue checks are not being conducted and documented which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/24/2022
Plan of Correction
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Licensee agress to start to check and document infnat 15 mintue checks. Licensee will submit proof via email to [email protected] by 11/24/2022.
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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


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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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
VISIT DATE: 11/17/2022
NARRATIVE
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LPA observed the outdoor yard to be completely fenced. LPA observed the exit doors to be secured. The outdoor yard provides plenty of shading for the children in care. Drinking water is provided by means of individual cups. Toys, furniture, and equipment observed in the outdoor yard are age appropriate and in good conditions. No bodies of water are observed.

LPA reviewed Licensee, assistants and children's records. LPA notes children files were available for all children present during today’s inspection. Licensee reported not documenting infant 15-minute check during napping. Licensee understands that 15-minute checks are required for all children under the age of two (2) and stated FCCH will start documenting all infant’s napping. In addition, out of the ten (10) children present, five (5) were not documented in the facility roster. Licensee agrees to update facility roster. LPA reviewed Licensee’s Pediatric First -aid certificate that is valid until 8/14/23 and Licensee's Mandated Reporter training certification expires 6/1/24. LPA notes that both assistants do not have Mandated Reporter certificate. In addition, there is no personnel file for Esperanza Correa (Licensee’s parent). The Licensee informed LPA no firearms and ammunition are on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an

for additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
VISIT DATE: 11/17/2022
NARRATIVE
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https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Type B deficiencies are being cited based on LPA’s record reviews, and observations pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Esperanza Correa in Spanish due to Spanish being Licensee's primary language.

LPA notes that around 12:00 pm, Licensee placed security latch on fireplace. Licensee's son was able to go purchase one during inspection. LPA also notes that around 12:20pm, Licensee's daughter, Jessica Garcia dropped off Licensee's emergency disaster plan. Both of these deficiencies have been cleared.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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