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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215020
Report Date: 05/22/2024
Date Signed: 05/22/2024 01:11:59 PM


Document Has Been Signed on 05/22/2024 01:11 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:LEMOINE-BECERRA FAMILY CHILD CAREFACILITY NUMBER:
406215020
ADMINISTRATOR:JAMIE LEMOINE-BECERRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 458-5433
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 0DATE:
05/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jamie Lemoine- BecerraTIME COMPLETED:
01:30 PM
NARRATIVE
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On 5/22/24, Licensing Program Analysts (LPAs) Elvin Baddley and Joaquin Mendez conducted unannounced Case Management inspection to the aforementioned Family Child Care Home (FCCH). LPAs met with Jamie Lemoine- Becerra, Licensee of the FCCH, and explained the nature of the inspection. LPAs notes no children are on site and the facility's operation ceased on 5/17/24, according to the Licensee.

LPAs addressed an injury of a child in care, C1, at the FCCH and the location of staff members. Upon discussing the location of Licensee, Assistants (S1 and S2) informed LPAs the Licensee "is always" at the facility. The statements provided by the Assistants contradicted the fact the Licensee is not always on site the required amount of time.

As such a Type A deficiency is be sited. Upon receipt of this report, Licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy.

A closing interview was conducted with Licensee and a Plan of Correction was discussed. Licensee was provided and advised of Appeal Rights. Licensee's signature at the bottom of this report acknowledges Licensee received the reports and understand their rights.

The Notice of Site Visit was also provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
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 05/22/2024 01:11 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
CCLD Regional Office, 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: 05/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2024
Section Cited
CCR
102402(a)(3)

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The Department has the authority to suspend or revoke a license on any of the grounds specified in Health and Safety Code Section 1596.885.Conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of this state...
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Licensee will immediately adhere to the Health and Safety Code Section 1596.885. Licensee to outline a plan noting how Licensee will be at the FCCH the required amount of time per day. Plan of Correction to be provided to CCLD
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This requirement is not met as evidenced by: FCCH Assistants informing LPAs Licensee is always at the facility 5/10/24 and 5/15/24, which contradicts the fact Licensee was not at FCCH the required amount of time from 4/1/24 to 5/1/24.
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 (elvin.baddley @dss.ca.gov) no later than 5/23/24.the close the of business.

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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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2024
LIC809 (FAS) - (06/04)
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