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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215464
Report Date: 06/12/2025
Date Signed: 06/12/2025 10:26:20 AM

Document Has Been Signed on 06/12/2025 10:26 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KAHAE FCC AKA ALOHA KEIKI DAY CAREFACILITY NUMBER:
426215464
ADMINISTRATOR/
DIRECTOR:		THERESA ANNE KAHAEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 720-0505
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
06/12/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Theresa Ann KahaeTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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On June 12, 2025, at 8:45 AM, Licensing Program Analyst (LPA) Elizabeth George conducted an unannounced annual random inspection at the above-mentioned family child care home (FCCH). LPA met with Licensee Theresa Ann Kahae and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. At the time of the inspection one child was present.

Licensee stated that children have access to the living room, dining room, bathroom, and backyard. While the 2nd floor, two bedrooms and garage are completely inaccessible to children in care. LPA notes that there is a gate making the kitchen inaccessible to children in care. Stairs are made inaccessible to children by a gate at the base of the stairwell. The home was orderly and clean with proper ventilation for all children in care. The bathroom used for care is clean. During the inspection licensee move items that could be potentially hazardous out of reach of children. Discussed with Licensee the importance of continuing to make sure that items that could be hazardous to children, including those that indicate "KEEP OUT OF REACH OF CHILDREN" are made inaccessible to children. LPA observed a fireplace in the living room that is blocked by a baby gate. Licensee stated that sharps, knives, and cleaning compounds are stored in off-limit areas of the FCCH. Medications are stored in an upper locked cabinet in the hallway. LPA observed furniture and equipment that are age appropriate.

LPA observed required licensing forms and documents posted by the entrance of the facility. LPA observed a carbon monoxide detector which was tested and found operable at 9:05am. Smoke detector was observed in the home, licensee stated it is tied in with the fire alarm and was unable to test it. LPA observed a regulation fire extinguisher that was serviced 10/8/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The most recent fire drill was conducted and documented on 6/24/24. LPA reminded licensee fire drills should be conducted every six months.

Continued on 809-C

Ana TolentinoTELEPHONE: (805) 562-0437
Elizabeth GeorgeTELEPHONE: (805) 680-7175
DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2025
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.

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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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464
VISIT DATE: 06/12/2025
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LPA observed the backyard to be completely fenced. The FCCH was observed to have plenty of shade for the children in care. Toys and play equipment observed in backyard are age appropriate and in good conditions. LPA reminded licensee to remove items in the backyard that could be potentially harmful to children in care. LPA observed one shed in the outdoor play area that is locked and inaccessible. LPA observed a baby gate making one side of the backyard inaccessible to children in care. LPA observed a small trampoline and discussed with licensee the requirement to follow manufacture guidelines. LPA observed no bodies of water on site. Licensee informed LPA no firearms or ammunition are in the home.


A sample of children’s records was reviewed. All records reviewed are current. Facilities current roster of children was reviewed by the LPA during inspection with all children present during the inspection noted in the roster. Licensee stated the one infant in care does not nap during the day and therefore no sleep logs were reviewed. Licensee’s Pediatric CPR and First Aid certifications are current and expire on 11/24/26. Mandated Reporter Training Certification expired on 1/19/25. Currently licensee does not employ additional personal. LPA discussed with and provided licensee with Entrance Checklist (LIC126) with required forms to be kept in staff files.

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.

Continued on 809-C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Elizabeth GeorgeTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464
VISIT DATE: 06/12/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

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 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.

During the exit interview, the Licensee Theresa Ann Kahae, 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 Type B citations were issued for under CCR, Title 22 and Health and Safety Code and can be found on the attached 809-D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeals rights were provided and report was reviewed with the licensee, Theresa Ann Kahae.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Elizabeth GeorgeTELEPHONE: (805) 680-7175
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2025 10:26 AM - It Cannot Be Edited


Created By: Elizabeth George On 06/12/2025 at 10:01 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: KAHAE FCC AKA ALOHA KEIKI DAY CARE
FACILITY NUMBER: 426215464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in fire drills have not been conducted every 6 months which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2025
Plan of Correction
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Licensee will submit a plan of action on how fire drills will be conducted every 6 months. Licensee will also conduct a fire drill and document it. These two documents will be emailed to LPA at elizabeth.george@dss.ca.gov no later than June 20, 2025.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in Mandated Reporter certification is not current which posesd a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/20/2025
Plan of Correction
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Licensee will complete the mandated reporter certification and send certificate to LPA via email at elizabeth.george@dss.ca.gov no later than June 20, 2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (805) 562-0437
Elizabeth George
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (805) 680-7175
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2025


LIC809 (FAS) - (06/04)
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