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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566206919
Report Date: 01/27/2020
Date Signed: 01/27/2020 02:40:02 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:ALARCON FCC AKA GUARDIAN ANGEL DAY CAREFACILITY NUMBER:
566206919
ADMINISTRATOR:JACQUELINE ALARCONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 512-2939
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:14CENSUS: 15DATE:
01/27/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Jaqueline AlarconTIME COMPLETED:
02:30 PM
NARRATIVE
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A case management inspection was conducted by LPA S. Mendoza-Ceja who met with licensee Jacqueline Alarcon and her assistant. At the visit, LPA observed licensee to be caring for 15 children (two infants, six children 2 - 5 years, and seven school age children). LPA advised licensee she is operating beyond the capacity of the license. Licensee stated one of the parent's was late picking up children. At approximately, 1:50 PM, one of the parents arrived and picked up two of the day care children, including licensee's own child. The capacity has now reduced to 12 children.

The following Type A deficiencies is cited on page 2 in regards to staffing, ratio and capacity according to CCR, Title 22, Division 12. Licensee has been provided a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports.

Licensee shall post these reports for 30 days and provide copies of the licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Appeal Rights were reviewed.

Failure to post the "Notice of Site Visit" for 30 days may result in a $100.00 Civil Penalty.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2020
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: ALARCON FCC AKA GUARDIAN ANGEL DAY CARE
FACILITY NUMBER: 566206919
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2020
Section Cited

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Staffing Ratio and Capacity: For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home, including children under age 10 who reside at the licensee's home and the assistant provider's children under age 10, shall be either: More than twelve and up to fourteen children only if the criteria in Section 1597.465 of the Health and Safety Code are met.
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This requirement was not met based on LPA's observation, interview, and record review: the Licensee failed to be in compliance when she exceeded the licensed capacity of 14 when she was providing care to 15 children. This poses an immediate Health, Safety, or Personal Rights risk to 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2020
LIC809 (FAS) - (06/04)
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