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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 05/18/2022
Date Signed: 05/18/2022 11:52:58 AM


Document Has Been Signed on 05/18/2022 11:52 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
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: 7DATE:
05/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alyssa Correa TIME COMPLETED:
12:10 PM
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On 05/18/2022 at 10:00 am, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Proof of Correction (POC) Inspection at the above Family Child Care Home (FCCH).LPA met with Licensee, Alyssa Correa and explained the purpose of this inspection. LPA conducted pre-screening questionnaire related to COVID - 19 and based on licensee's responses it was determined that the home was safe and free of any COVID -19 exposure on site. LPA notes that seven (7) children were present being supervised by Licensee and Assistant, Ashley Correa.

On 05/17/2022 the Licensee/FCCH was cited of the following Type A deficiencies:
1. 102416.5 - The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. During today’s inspection, licensee was operating within her capacity. LPA observed Licensee and Assistant providing care and supervision to seven (7) children.

On 05/17/2022 the Licensee/FCCH was cited of the following Type B deficiencies:
1. 102421 - The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419. During today's inspection, LPA conducted file reviews for all children present during inspection and found children files to be complete and current. Licensee reported that four (4) children did not attend due to be out of date with immunizations.

2. 102425 - Cribs or play yards shall be free from all loose articles and objects. During today's inspection, LPA observed infant crib to be free of any loose objects.

3. 102425(j)(d) The provider shall supervise infants while they are sleeping and adhere to the following requirements: Documentation shall be maintained in the infant’s file...for review. Documentation shall include...a. Date b. Infant’s name c. Time of each 15- minute check. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
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: 05/18/2022
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During today's inspection, LPA reviewed 15 minute logs for all infants present in the facility. Licensee understand that 15 minute logs are required for all children under 2 years of age. During inspection, LPA observed Licensee documenting 15 minute checks as infants slept.

The following Type A deficiency are now cleared: CCR 102416.5. The following Type B deficiencies are now cleared: CCR 102421, CCR 102425(b), CCR102425(j)(d).

LPAs recommended Licensee to attend the virtual Spanish orientation for refresher purposes which the licensee agreed to. LPA also recommends Licensee attend a Safe Sleep Regulation course offered by resource and referral. LPA also recommends Licensee participated in Technical Support Program for continual guidance on Title 22 regulations.

Today, no citations were cited.

Today's visit and review of report was translated in Spanish by LPA Francisca Velazquez due to spanish being the primary language of the Licensee.



Notice of Site Visit was issued. Exit interview was conducted with Licensee, Alyssa Correa.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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