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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212416
Report Date: 03/28/2025
Date Signed: 03/28/2025 01:05:23 PM

Document Has Been Signed on 03/28/2025 01:05 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MAGANA-MENDEZ FCCFACILITY NUMBER:
566212416
ADMINISTRATOR/
DIRECTOR:		ALICIA MENDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 814-7167
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
03/28/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Alicia MendezTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
NARRATIVE
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On March 28, 2025, at 09:20 AM, Licensing Program Analyst (LPA) Fernando Hernandez conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH). LPA met with Licensee, Alicia Mendez. LPA discussed the purpose inspection. FCCH operating hours are Monday to Friday from 6:00 AM to 5:00 PM, provides care to children between 0 months to 13 years old.

During the inspection, LPA and Licensee toured the inside and outside of the home. LPA observed 5 children in care under the supervision of licensee. LPA notes the home is a one-story home. The Accessible area in the home includes, front yard, dining area, one bathroom, and (1) playroom/living room for napping and daily activities. The garage, (3) bedrooms, backyard, kitchen, laundry room and (1) bathroom remain inaccessible to children. LPA notes, a child safety gate is in place by the living room making the off-limit areas inaccessible to children during day care. LPA notes, the licensee guides the children to the (1) restroom crossing the kitchen and laundry room, ensuring off-limit areas are inaccessible to children in day care. The required licensing forms are posted in the prominent location. Filtered water is accessible to children in care by means of individual water cups.
Continued on LIC 809-C
Susana MartinezTELEPHONE: (805) 562-0400
Fernando HernandezTELEPHONE: (805) 883-8244
DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 03/28/2025 01:05 PM - It Cannot Be Edited


Created By: Fernando Hernandez On 03/28/2025 at 11:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 2 [children's infant sleep charts were found incomplete] which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/07/2025
Plan of Correction
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Licensee at the time of the inspection documented every 15 mins and stated they will ensure children's infant sleep charts are complete.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
TELEPHONE: (805) 562-0400
Fernando Hernandez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (805) 883-8244
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2025


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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416
VISIT DATE: 03/28/2025
NARRATIVE
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 LPA observed age-appropriate toys and equipment, cots and play pens inside the home. Knives and cleaning materials are stored inaccessible to the children in care. LPA observed the front yard to be completely fenced by wooden fence secured by lock. The bathroom for children’s use is free of toxins. Licensee confirmed there are no firearms and ammunition in the home.

LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 04/08/2026 while the Mandated Reporter Training Certificate expired on 03/17/2025. LPA reminded Licensee that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher (2A10BC) was serviced on 03/11/2025. Carbon monoxide and smoke detectors were tested and found functional. FCCH conducts fire and disaster drill every six months and last drill was conducted on 10/09/2024.

LPA reviewed children's records. Records reviewed were complete and contained required licensing documentation and forms. LPA reviewed 2 out of 2 children’s infant safe sleep documentation to be incomplete for all infants under the age of two years. Licensee stated they do not keep their infant safe sleep charts for 3 years. LPA reminded the licensee of the importance to keep each child’s infant safe sleep chart for 3 years. LPA provided licensee with a copy of the infant safe sleep chart and licensee stated she will start documenting 15-minute sleep checks for all infants under the age of 2 years and keep their records for 3 years.

Continued on LIC 809-C Page 3

SUPERVISOR'S NAME: Susana MartinezTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Fernando HernandezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416
VISIT DATE: 03/28/2025
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Continued on LIC 809-C Page 4

SUPERVISOR'S NAME: Susana MartinezTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Fernando HernandezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: MAGANA-MENDEZ FCC
FACILITY NUMBER: 566212416
VISIT DATE: 03/28/2025
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LPA also informed licensee, the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Licensee is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During the exit interview, the LICENSEE, Alicia Mendez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today’s inspection, (2) Technical Violations and (1) Type B was cited upon record review (please see attached LIC809D and (2) LIC9102). Plan of Corrections (POC) will be submitted by licensee to LPA Hernandez via email by end of business day 04/07/2025.

Notice of Site Visit was issued and must be posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Alicia Mendez

SUPERVISOR'S NAME: Susana MartinezTELEPHONE: (805) 562-0400
LICENSING EVALUATOR NAME: Fernando HernandezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
LIC809 (FAS) - (06/04)
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