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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215866
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:30:59 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:CORREA FAMILY CHILD CAREFACILITY NUMBER:
426215866
ADMINISTRATOR:ESPERANZA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-1854
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 10DATE:
08/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Esperanza CorreaTIME COMPLETED:
04:45 PM
NARRATIVE
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On 8/25/21 at 2:10 PM, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required Inspection of the facility. Prior to entering the facility, LPA conducted pre-screening COVID-19 questionnaire and based on Licensee’s responses it was determined that the facility is safe and free from any COVID-19 exposures. LPA meet with Esperanza Correa, Licensee of the facility and explained the purpose of the inspection. LPA in the company of the Licensee, toured the interior and exterior of the home. This is a two story home with five (5) bedrooms, four (4) bathrooms, living room, dining area, kitchen, laundry room, garage and backyard. Licensee stated that living room, dining area, restroom and backyard are accessible to the children in care. While the whole second floor, kitchen, laundry room and garage are inaccessible to the children in care. During the time of the inspection, Licensee was caring for ten (10) children and was present with Assistant, Alyssa Correa.

At 2:14 PM, LPA observed infant child in a car seat in the living room of the facility. Assistant, removed child from car seat during inspection.

LPA observed required forms posted in the wall as you enter the facility. LPA observed a combination smoke and carbon monoxide detector in the ceiling of the living room in the facility. Detector was tested at 2:30 PM and was found to be operational. The home has a regulation fire extinguisher that was purchased today 8/25/21. LPA reminded Licensee that fire extinguisher needs to be either service or purchase annually. The home maintains working telephone services. LPA observed a fireplace in the living room that is covered and inaccessible to children in care. LPA observed that there is a small gate in the bottom step of the stairway, making the second floor inaccessible to children in care. LPA observed that the kitchen, laundry room and garage are made inaccessible by a small gate closing off the kitchen area. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
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 6
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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
VISIT DATE: 08/25/2021
NARRATIVE
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LPA observed all cleaning supplies and toxins are stored in the garage and are inaccessible to children in care. LPA observed that Licensee stores sharps in a high cabinet in the kitchen that are inaccessible to children in care. The facility is orderly, clean and has ventilation for child care services. The restroom used for children was found to be clean and orderly and has plenty of hand soap, paper towels and hand washing poster for children. Medication in the facility is stored in a high cabinet in the kitchen and are inaccessible to children. Toys and equipment observed in the facility are age appropriate.

Licensee stated that children have access to the backyard. LPA observed that the backyard is completely fenced. Licensee shared that when children play outdoors, they are always supervised by an adult. LPA observed plenty of gross motor activities and plenty of shade for the children in care. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the facility.

A sampling of the children's record was reviewed and found to have current and up to date with emergency information cards and personal rights. Child files reviewed did not have up-to-date immunization blue card. During file review, LPA observed that C5 did not have a child file accessible in the facility. The Licensee's records indicate Mandated Reporter training certificate expires 7/3/22. LPA reminded Licensee that AB1207 must be updated every two years. Licensee’s CPR and First Aid certifications expires on 8/14/23. LPA review emergency drill log and observed the last emergency drill was conducted and documented today 8/25/21. LPA reminded Licensee that emergency drills are required every six (6) months and need to be documented. Review of Assistant's records indicate that AB1207 expires 1/16/23 and CPR/First-aid expires 1/18/22.



CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
VISIT DATE: 08/25/2021
NARRATIVE
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The Licensee is not providing 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: www.ada.gov/childqanda.htm

LPA discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it is Licensee's responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. LPA and Licensee discussed safe sleep regulations. LPA provided a copy of new Safe Sleep Regulations and LIC 9227 Individual Infant Sleep Plan for Licensee to review. Licensee currently has three (3) infant age children enrolled for services.

In areas evaluated, there were deficiencies cited during today's visit.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
VISIT DATE: 08/25/2021
NARRATIVE
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Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Licensee Esperanza Correa. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:

LPA provided Licensee with Notice of Site visit (LIC 9213) which was posted by the Licensee.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/26/2021
Section Cited

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102425(h) Infant Safe Sleep- Car seats shall only be used for transportation purposes and shall not be used for sleeping. This requirement was not met as evidence by:
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During inspection, LPA observed infant child in a car seat in the living room of the faciliyt. This is an immediate health and safety risk to the children in care.
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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: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426215866
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2021
Section Cited

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102421 Child's Records- (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). This requirement is not met as evidence by:
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During file review, LPA observed that C5 did not have a file in the facility. This is a potential health and safety risk to the children in care.
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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: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2021
LIC809 (FAS) - (06/04)
Page: 6 of 6