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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 05/26/2022
Date Signed: 05/26/2022 01:41:01 PM

Document Has Been Signed on 05/26/2022 01:41 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 FCC AKA ALYSSA'S CHILD CAREFACILITY NUMBER:
426216168
ADMINISTRATOR:ALYSSA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 966-1964
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
05/26/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Alyssa CorreaTIME COMPLETED:
12:24 PM
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On 05/26/2022 at 10:20 AM Licensing Program Analysts, (LPAs) Gigi Reyes and Rosie Breault conducted an unannounced Proof of Correction (POC) Inspection and met with Licensee, Alyssa Correa and Assistant Ashley Correa. LPAs explained the purpose of the inspection. LPAs asked pre-screening questions related to COVID - 19 and based on assistant's responses there was no COVID -19 exposure on site. LPAs observed 11 children and 2 staff present. One child was picked by Jessica Garcia another assistant and was dropped off to school.

On 05/17/2022 the Licensee/FCCH was cited of the following Type A deficiency :
1. 102416.5 - The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time.
During today’s inspection, licensee was operating within capacity limit, there were 11 children present 4 of whom are infants and 7 of the children are over the age of 2 years old

On 05/17/2022 the Licensee/FCCH was cited of the following Type B deficiencies:
1. 102421 - The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419.
During today's inspection, LPAs reviewed the files for all children present and found children files to be complete and current. Files were created for C1, C2 and C3. C4 did not come back to day care.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
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
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 FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168
VISIT DATE: 05/26/2022
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2. 102425 - Cribs or play yards shall be free from all loose articles and objects. During today's inspection, LPA observed infant crib to be free of any loose objects.

3. 102425(j)(d) The provider shall supervise infants while they are sleeping and adhere to the following requirements: Documentation shall be maintained in the infant’s file...for review. Documentation shall include...a. Date b. Infant’s name c. Time of each 15- minute check. During today's inspection, LPAs reviewed 15 minute logs for all infants present in the FCCH. Licensee was observed documenting the sleeping infants every 15 minutes.

The following Type A deficiency are now cleared: CCR 102416.5. The following Type B deficiencies are now cleared: CCR 102421, CCR 102425(b), CCR102425(j)(d).

LPAs observed that LIC 9224 Acknowledgement of Licensing Reports are on children's file.

During today's inspection, no deficiencies were cited.

Evaluation Report was reviewed and translated in Spanish by Assistant, Ashley Correa



Notice of Site Visit was issued. Exit interview was conducted with Licensee and Assistant Alyssa Correa.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC809 (FAS) - (06/04)
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