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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215781
Report Date: 05/18/2023
Date Signed: 05/23/2023 07:10:56 PM


Document Has Been Signed on 05/23/2023 07:10 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:MELENDEZ-SANTOS FAMILY CHILD CAREFACILITY NUMBER:
566215781
ADMINISTRATOR:CATRINA MELENDEZ-SANTOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 710-7385
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:14CENSUS: 9DATE:
05/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Catrina Melendez-SantosTIME COMPLETED:
02:30 PM
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On 05/18/2023, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management inspection of the Family Child Care Home (FCCH), to follow up on a self-reported Unusual Incident Report (UIR) received by the Department on 11/07/22 concerning an unresponsive infant, herein C1 being air-lifted to LA medical center from Simi Valley hospital for having a seizure at the facility. LPA notes licensee contacted medical personnel, via a 911 call on 11/3/22, following C1 being unresponsive during C1’s nap. At the hospital it was discovered C1 had two hematomas on his head after x-ray and MRI was conducted.

LPA met with Catrina Melendez-Santos, licensee of the FCCH and explained the nature of the inspection. LPA notes 9 children are on site along with licensee and assistant/licensee’s spouse providing care and supervision.

C1 is not on site and is no longer receiving care from the FCCH, per licensee C1 is in care of the mother. Licensee informed LPA she has been interviewed by our department and Simi Valley Police department.

The Regional Office conducted their investigation through IB. The detective advised they did not uncover information to suggest the victims injuries occurred at the facility.

No deficiencies are cited during today's inspections and a Notice of Site Visit to be posted along with Appeal Rights is being provided to the licensee, Catrina Melendez-Santos.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023
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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