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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215057
Report Date: 04/14/2025
Date Signed: 04/14/2025 02:15:59 PM

Document Has Been Signed on 04/14/2025 02:15 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:MENDOZA FAMILY CHILD CAREFACILITY NUMBER:
406215057
ADMINISTRATOR/
DIRECTOR:		MARIA MENDOZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 473-2802
CITY:OCEANOSTATE: CAZIP CODE:
93445
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
04/14/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:18 PM
MET WITH:Maria MendozaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 04/14/2025 at 1:18 PM, Licensing Program Analysts (LPAs) Shane Loftus and Cynthia Alvarez conducted an unannounced Annual Random inspection of the facility. The LPAs met with Maria Mendoza, Licensee of the FCCH and explained the purpose of the inspection. LPAs, in the company of Licensee, toured the interior and exterior of the FCCH. LPAs observed one (1) child in care during today’s inspection.

This home consists of three (3) bedrooms, (2) bathrooms, living room, dining room, kitchen, laundry room, garage and outdoor yard. LPAs note day care services occur in the living room, dining room, kitchen, one (1) bedroom, one (1) bathroom, and outdoor yard. Meanwhile, two (2) bedrooms, one (1) bathroom, laundry room, and garage are off limits. LPAs observed door safety knobs on the bedrooms and baby gates making the kitchen and laundry area inaccessible to children in care. The home has a fireplace that is covered with a glass screen

The home was clean, orderly and has ventilation to afford for the children’s comfort and safety. Further, the home was void of hazardous items. LPAs observed sharps are stored in an elevated kitchen cabinet. Medication for the family is stored in the Licensee’s bedroom. Cleaning compounds/toxins were observed stored in the laundry room. LPAs note that these areas are inaccessible to the children in care. Toys, furniture and equipment observed in the home are safe, varied and age appropriate.

Required forms are predominantly posted on the wall of the home. LPAs observed and tested smoke and carbon monoxide detectors at 1: 21 PM and was operable during inspection. The home has a regulation fire extinguisher which was serviced on 03/04/25. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. Continued 809-C

Maria MuellerTELEPHONE: (805) 562-0400
Shane LoftusTELEPHONE: (805) 562-0400
DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 406215057
VISIT DATE: 04/14/2025
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The backyard is completely fenced. The fence’s entry/exit gates were secure. LPAs observed a shed in the backyard that was locked and inaccessible to children in care. LPAs observed plenty of shade, gross motor activities with cushion in all fall zones accessible to children in care. Toys and play equipment observed in backyard are safe, varied, age appropriate and in satisfactory condition. No bodies of water were observed on site.

LPAs reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records. A review of the FCCH's fire drill log shows the last drill occurred 03/05/25. The Licensee's records were reviewed. Licensee’s pediatric CPR and First Aid certification was taken on 12/01/24. Licensee’s Mandated Reporter training certificate was taken 05/01/24. No firearms or 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.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Continued 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: MENDOZA FAMILY CHILD CARE
FACILITY NUMBER: 406215057
VISIT DATE: 04/14/2025
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During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS.

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.

No deficiencies were cited during today's inspection. A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Maria Mendoza. Licensee's preferred language is Spanish.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Shane LoftusTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC809 (FAS) - (06/04)
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