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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215020
Report Date: 05/10/2024
Date Signed: 05/10/2024 06:34:02 PM


Document Has Been Signed on 05/10/2024 06:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:LEMOINE-BECERRA FAMILY CHILD CAREFACILITY NUMBER:
406215020
ADMINISTRATOR:JAMIE LEMOINE-BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
8054585433
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 6DATE:
05/10/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jamie Lemoine BecerraTIME COMPLETED:
04:00 PM
NARRATIVE
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On May 10,2024 at 08:30AM, Licensing Program Analysts (LPA) Joaquin Mendez conducted an unannounced Required 1 Year inspection. LPA met with licensee Jamie Becerra and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. Inside the home has three (3) bedrooms, one (1) living room, three (3) bathrooms, one (1) classroom, a kitchen, and dining area. Licensee stated children in care do not have access to three (3) bedrooms, one (1) living room, two (2) bathrooms, the kitchen and dining room by way of safety door cover on door leading to kitchen permanently. There is a small room connected to the classroom used as a sign in room for parents to sign in and drop off children which has small stair case leading to the classroom which is made safe with a gate making it inaccessible to children in care without supervision. There were six (6) children in care with two (2) staff at the time of the inspection. There was another adult in the home and was confirmed to be Spouse and has been cleared for criminal history through Guardian.

LPA observed required licensing documents pinned on the walls throughout the home. Fire and earthquake drills are documented monthly. Last fire and earthquake drill conducted 4/18/2024. Fire extinguisher 2A10BC on the classroom wall was last serviced on 5/23/2023. Smoke detector tested at 9:14 am and carbon monoxide detector tested at 9:12am and were observed and tested to be in functioning at the time of inspection. Licensee stated there was no firearms or ammunition in the home.

Continue on 809C pg 2
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 682-7647
LICENSING EVALUATOR NAME: Joaquin MendezTELEPHONE: (805) 951-0654
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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 5


Document Has Been Signed on 05/10/2024 06:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: LEMOINE-BECERRA FAMILY CHILD CARE
FACILITY NUMBER: 406215020

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/28/2024
Plan of Correction
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Licensee will provide a copy of proof for CPR certification for Licensee and staff by 5/28/2024 to LPA
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) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/28/2024
Plan of Correction
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Licensee will provide proof of correction by sending a copy of CPR certification by 5/28/2024 to LPA
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 MuellerTELEPHONE: (805) 682-7647
LICENSING EVALUATOR NAME: Joaquin MendezTELEPHONE: (805) 951-0654
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEMOINE-BECERRA FAMILY CHILD CARE
FACILITY NUMBER: 406215020
VISIT DATE: 05/10/2024
NARRATIVE
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Children in care have access to one (1) Classroom, one (1) restroom located in the classroom, and back yard play area. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is fenced with appropriate toys and structures for children in care. Backyard play area is provided plenty of shade by way of large tree on property. Licensee mentioned she is ordering a sail type covering to encompass all play area for children in care. LPA did not observe any bodies of water. During the tour, LPA did not observe any hazards/toxins items accessible to children in care. LPA observed all cleaning supplies in an upper cabinet located in the classroom and inaccessible to children in care.

LPA reviewed three (3) children’s files during visit, files were complete. LPA advised Licensee that CPR/first aid was missing from licensee and employee files. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the First aid/CPR training and renew certification every two (2) years. Mandated Reporter training certificate was on file for all staff. Mandated reporter certificate expirations for staff; Jamie Becerra 3/29/2026, Haylee Ferrell 3/27/2026, Mia Herndon 3/27/2026. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

Continue 809C Pg3
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 682-7647
LICENSING EVALUATOR NAME: Joaquin MendezTELEPHONE: (805) 951-0654
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEMOINE-BECERRA FAMILY CHILD CARE
FACILITY NUMBER: 406215020
VISIT DATE: 05/10/2024
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 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 https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continue on 809C pg 4

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 682-7647
LICENSING EVALUATOR NAME: Joaquin MendezTELEPHONE: (805) 951-0654
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: LEMOINE-BECERRA FAMILY CHILD CARE
FACILITY NUMBER: 406215020
VISIT DATE: 05/10/2024
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Licensee stated there were no children in care that required Incidental Medical Services. 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 informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Jamie Becerra, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's inspection two (2) type B deficiencies were cited and appeal rights were given and notice of site visit was issued.

Exit interview was conducted and report was reviewed with licensee Jamie Becerra.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 682-7647
LICENSING EVALUATOR NAME: Joaquin MendezTELEPHONE: (805) 951-0654
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5