<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215866
Report Date: 10/06/2023
Date Signed: 10/06/2023 10:56:23 AM

Document Has Been Signed on 10/06/2023 10:56 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: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: 11DATE:
10/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Esperanza CorreaTIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/6/23, Licensing Program Analysts (LPAs) Francisca Velazquez and Elvin Baddley conducted an unannounced Case Management- Deficiencies. LPAs met with Licensee, Esperanza Correa and informed her of the purpose of this inspection. LPAs toured the interior and exterior of the facility. LPAs observed 11 children present along with 4 assistants and licensee.

At 10:00 AM, LPAs collected names of all the children present in the facility. Licensee disclosed that C1 has been recently enrolled in the facility. LPAs reviewed C1's file and found that C1's did not have LIC 9224 for any of the Type A deficiencies cited in the last year. In addition, C1's file did not have LIC 9224 for a Non-Compliance Conference (NCC) that occurred at the Regional Office on 8/7/23. Upon informing Licensee of the aforementioned, Licensee informed LPAs the LIC 9224 forms for the 8/7/23 NCC had not been provided to any enrolled families.

During today's inspection, Type B deficiency is being cited. Appeal Rights were given in both English and Spanish.

Exit interview and review of report was conducted with Licensee, Esperanza Correa. Licensee understands notice of site visit must be posted for the next 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/06/2023 10:56 AM - It Cannot Be Edited


Created By: Francisca Velazquez On 10/06/2023 at 10:32 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: 10/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
102419(j)

1
2
3
4
5
6
7
Admission Procedures and Parental and Authorized Representative's Rights- (j) Copies of the signed receipt shall be available to the Department as provided in Section 102391(d). This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensed agrees to collect LIC 9224 for all enrolled families. Licensee will submit proof by 10/13/23 via email to [email protected]
8
9
10
11
12
13
14
LPAs observed C1's file did not have LIC 9224 for Type A deficiencies received in the past year and LIC 9224 for a non-compliance conference that occurred at the Regional Office on 8/7/23. This is a potential risk to the health, safety and personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 10/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2