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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 05/06/2022
Date Signed: 05/09/2022 05:51:27 PM


Document Has Been Signed on 05/09/2022 05:51 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:CORREA FCC AKA ALYSSA'S CHILD CAREFACILITY NUMBER:
426216168
ADMINISTRATOR:ALYSSA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 966-1964
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 17DATE:
05/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alyssa CorreaTIME COMPLETED:
04:00 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

Licensing Program Analyst (LPA) Francisca Velazquez made an unannounced visit. to initiate complaint investigation regarding allegation. A Case Management - Deficiency was identified during the inspection to document deficiencies observed during this inspection. LPA met with Licensee, Alyssa Correa and together toured the facility inside and out. LPA observed seventeen (17) children in care at the time of the inspection along with assistant, Ashely Correa. LPA notes that within ten minutes of initiating visit, one (1) more assistant, Jessica Correa arrived at the facility. Therefore, seventeen (17) children were being supervised by three (3) adults during this inspection.

At approximately 10:12 AM, LPA observed the safety gate located in the first step of the stairway to not be secured, therefore the second floor was accessible to children in care. Licensee stated that Licensee’s sister left the gate open.

At approximately 10:16 AM, LPA observed eight (8) children in the day-care room.

At approximately 10:16 AM, LPA observed an open face fireplace located in the children day-care room that was not locked and/or secured. LPA observed that safety gate was propped in front of the fire-place but was not secured or locked, therefore accessible to children in care. Cont 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168
VISIT DATE: 05/06/2022
NARRATIVE
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At approximately 10:16 AM, LPA observed Windex which indicated “Keep out of children reach,” stored under the unlocked children bathroom sink accessible to children. LPA observed that there was no lock or safety latch making the area accessible to children in care.

At approximately 10:17 AM, LPA observed that the door to the laundry room was closed but did not have a lock or safety latch making the laundry room accessible to children in care. LPA observed cleaning compounds (Tide and Oxyclean detergent in the laundry room that were accessible to children in care.

At approximately 10:18 AM, LPA observed two (2) additional infants in a bedroom. LPA observed infant C10 was standing up in the crib and C11 was on the floor. LPA observed baby bottles and one large adult size blanket in the crib with C10. LPA observed that the bedroom door was closed and there were no adults with the infants in the bedroom. LPA observed an infant vibrating chair in this bedroom, this item is not allowed in licensed facilities.

At approximately 10:23 AM, two (2) additional children walked into the daycare room from the outdoor yard.

At approximately 10:25 AM, LPA and Licensee toured the outdoor yard and observed an additional five (5) children present in the outdoor yard.

Once LPA completed the interior and exterior tour it was noted that there are seventeen (17) children present, along with three (3) adults providing care and supervision. Licensee is licensed for 14 children.

At 10:30 PM, LPA toured the garage. LPA observed the garage to be set up for day care purposes. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 5 of 9
Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2022
Section Cited

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (D)Documentation shall be maintained in the infant’s file...for review. Documentation shall include the following: a. Date b. Infant’s name c.Time of each 15-minute check. This requirement is not met as evidence by:
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During inspection, Licensee stated that 15 mintue check is not documented becasue she supervises the children all the time and did not think that she need to document the time if chidlren were being supervised. This is a potential risk to the health and safety of 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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2022
Section Cited

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102417 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 be limited to: (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841. This requirement is not met as evidence by:
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During inspection, Licensee did not have faciltiy roster readily avaialbe for review. This is a potential risk to the health and safety of chidlren 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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 9


Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2022
Section Cited

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(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (4) Poisons, detergents, cleaning compounds, medicines...pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:
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At 10:16 AM, LPA observed Windex accessible in the children bathroom under the sink. At 10:17 AM, LPA observe the door to the laundry room to be closed but did not have a safety/security latch making the room inacessible to chidlren in care. This is a potential risk to the health and safety of children in care.
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Type B
05/09/2022
Section Cited

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102421 Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidence by:
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During inspection, out of the seventeen (17) chidlren present, Licensee had three (3) files readily avaialbe for review. This is a potential risk to the health and saety of 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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 3 of 9


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 FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168
VISIT DATE: 05/06/2022
NARRATIVE
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After interviewing Licensee, Licensee stated that the garage is used for day care services. Licensee stated that Licensee was planning on calling the department to notify that the garage was being used but has not had time to call. The garage is an off-limit area at the time facility was licensed.

At 11:00 AM, LPA requested copy of facility roster. LPA notes that Licensee did not have a facility roster documenting all the children that have received services in her facility. LPA also requested children files for all the children present during this inspection. Licensee has three (3) children files out of the seventeen (17) in attendance available for review. LPA requested Licensee complete facility roster during this inspection.

The following CCR, Title 22, Division 12 regulations were cited during today’s inspection: Operation of a family child care home 102417(g)(3), 102417(g)(1), 102417(g)(4), 102417(g)(8). Child records 102421. Infant safe sleep 102425(j)(5)(a), 102425(j)(D), 102425(b). Staffing ratio and capacity 102416.5 (a).

Today, deficiency cited under Title 22 Division 12, Appeal rights were provided in Spanish.

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 of the report LIC 809 and LIC 809 D.



Today’s inspection and review of report was conducted in Spanish with Licensee, Alyssa Correa.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 9 of 9
Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2022
Section Cited

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102417 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 be limited to: (3) Where children less than five years old are in care, stairs shall be fenced or barricaded. This requirement was not met as evidence by:
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At 10:12 AM, LPA observed baby safety gate located on the first step of the stairway was not locked and open, therefore accessible to children in care. This is a potential health and safety risk to the children in care.
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Type B
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Section Cited

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102417 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 be limited to: (1) Fireplaces and open-face heaters shall be screened to prevent access by children. This requirement was not met as evidenced by:
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At 10:16 AM, LPA observed an open face fireplace located in the children day care room not covered and accessible to children in care. 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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 6 of 9


Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2022
Section Cited

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidence by:
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LPA observed seventeen (17) children present in the daycare during inspection. This is an immediate risk to the health and safety of chidlren in care.
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Type A
05/09/2022
Section Cited

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102425 INFANT SAFE SLEEP (b) Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidence by:
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At 10:18 AM, LPA observed C10 in the crib with two (2) baby bottles and one (1) large adult size blanket in the crib.
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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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 7 of 9


Document Has Been Signed on 05/09/2022 05:51 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2022
Section Cited

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(j) The provider shall supervise... and adhere to the following requirements: (5)If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. (A) The provider shall be able to visually observe the infant without moving the door. Tis requirement is not met as evidence by:
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During inspection, LPA observed two (2) infants in a bedroom. LPA observed the bedroom door was closed and no adult was in the room supervising the two (2) infants.
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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: 05/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2022
LIC809 (FAS) - (06/04)
Page: 8 of 9