426215565-3-3-2021-17-CC-MJIZ-BYS34S-20210303165538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426215565
Report Date: 03/03/2021
Date Signed: 03/03/2021 04:56:43 PM

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:	CHACON FAMILY CHILD CARE		FACILITY NUMBER:	426215565
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 6	DATE:	03/03/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Edis Chacon		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/3/21, at 2:40 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Case Management inspection of the above referenced Family Child Care Home (FCCH) for a change of capacity. LPA met with Edis Chacon, Licensee of the FCCH and explained the nature/purpose of the inspection. Due to COVID-19 and the California Department of Public Health's guidelines for social distancing, this inspection was conducted virtually, via the Face-Time. Prior to the commencement of the tele-inspection, LPA asked Pre- screening questions. The Licensee's responses to the Pre-screening questions suggest the facility is void of COVID exposures. During this tele-inspection, the Licensee provided the LPA an interior and exterior tour of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins which would pose a danger to the children in care. At the time of the inspection, the Licensee's was caring for 2 children. LPA reviewed he Licensee’s First Aid/ CPR certification which expires on 11/4/2022. LPA observed a regulation fire extinguisher which was last serviced on 2/3/2021. On 1/14/21, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Barbara Fire Department granted a fire clearance on February 4, 2021. CONTINUES ON LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

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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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: CHACON FAMILY CHILD CARE	FACILITY NUMBER: 426215565
	VISIT DATE: 03/03/2021

NARRATIVE

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LPA reviewed COVID-19 Self-Assessment Guide with applicant and observed that COVID-19 documents were posted. CONTINUES ON LIC 809C

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. There were no deficiencies cites at this time. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

The home meets Title 22 of CCR provisional requirements for a Large Family Child Care license effective today. Effective date is today March 3, 2021. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.

Exit interview was conducted with Edis Chacon, Licensee, via tele-inspection. This report along with a copy of the Notice of Site Visit will be sent to Ms. Chacon via email ,with a read receipt or confirmation of receipt of email, which will act as the Applicant's signature.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina Jimenez	TELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

LIC809 (FAS) - (06/04)

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