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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216619
Report Date: 05/06/2026
Date Signed: 05/07/2026 09:33:06 AM

Document Has Been Signed on 05/07/2026 09:33 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FLORES FCC AKA GENESIS FAMILY CHILD CAREFACILITY NUMBER:
406216619
ADMINISTRATOR/
DIRECTOR:		CARMEN FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 286-4209
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
05/06/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Carmen FloresTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 5/6/26, at 1:30 PM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced annual random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Carmen Flores, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The home is a 3 bedroom and 2 bathroom single story residence. The areas that are accessible for day care children are as follows: living room, dining room (main day care space), one bathroom, and backyard. The remainder of the home is excluded from childcare services. Inaccessible areas are made secure by child safety locks and gates. At the time of the inspection, LPA observed 8 day care children present, two of whom were infants. In addition the Licensee, LPA observed the Licensee's husband and one staff assistant on site (cleared and associated).

LPA observed the FCCH to be clean and orderly. The bathroom that is utilized for childcare is clean and free of toxins. LPA observed personal medications and sharps in elevated kitchen cabinets. No children currently require medication. Cleaning supplies are stored in an elevated space in the the locked laundry room.

LPA observed age-appropriate toys, furnishings, and equipment throughout the main playroom. In the living room, LPA observed a wood burning fireplace. LPA observed the fireplace to be enclosed by a metal screen making it accessible for children in care. Additionally in the home, LPA observed two dogs and one cat on site. Licensee relayed to LPA the pets are current on their vaccines, however, don't have interactions with children in care. LPA observed relevant licensing forms and documents posted prominently to a wall in the entrance of the home and in the main day care space. LPA also observed a separate smoke and carbon monoxide detector near the main day care room. (CONT. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2026
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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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: FLORES FCC AKA GENESIS FAMILY CHILD CARE
FACILITY NUMBER: 406216619
VISIT DATE: 05/06/2026
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At 2:01 PM, the smoke detector was tested, while at 2:02 PM, the carbon monoxide detector was tested and both were found to be operational. LPA observed a regulation fire extinguisher in the FCCH which was last serviced on 5/22/25. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the FCCH's fire/disaster drill log. The most recent disaster drill occurred on 2/24/26. LPA reminded the Licensee of the responsibility of conducting disaster drills at least once every six months.

As prior mentioned, the FCCH utilizes the backyard for outdoor play. The FCCH's outdoor area is enclosed by both chain linked and wooden fencing throughout. Like the main day care room inside of the FCCH, the outdoor area has age-appropriate play structures, toys, and other equipment throughout the area that can afford for fruitful childcare services. Licensee was reminded to replace toys and play equipment which start to degrade or are not in good repair. The footing of the exterior is made up of the following: dirt and concrete pavement. In the yard, LPA observed various trees and a metal pergola structure that can afford ample shade for children in care. LPA observed an outdoor bathroom and a large shed in the yard, each of which are off limits for children in care. In the backyard, LPA also observed a studio that is off limits for children in care. The information of the tenant (cleared and associated) that resides in the studio was provided by the Licensee. LPA observed no bodies of water present on the property and confirmed that this was the case with the Licensee. The Licensee attested to LPA that they always provide active supervision over children in care while outside. LPA advised the Licensee to inspect the outdoor area prior to letting children outside in order to ensure safety of children in care.



LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. The Licensee's records were also reviewed. LPA found that the Licensee completed their First Aid/CPR Training (EMSA approved) on 3/11/25 and their Mandated Reporter Training on 5/26/25. Licensee was reminded to renew certifications and training prior to expirations. The Licensee informed LPA that there are no firearms or ammunition that are stored on site.

The Licensee does not provide Incidental Medical Services (IMS) or administers medication to children in care. IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Family Child Care Homes and the ADA, available at: http://www.ada.gov/childqanda.htm.

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. (CONT. 809-C, Page 3)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
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: FLORES FCC AKA GENESIS FAMILY CHILD CARE
FACILITY NUMBER: 406216619
VISIT DATE: 05/06/2026
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LPA also informed Licensee of 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 was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

During today's visit, no citations were issued.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed an RSO profile in FAS on 5/6/26.

A notice of site visit was given and must remain posted for 30 days. Appeal rights were also given and signature on this form acknowledges receipt of these rights. Exit interview was conducted and report was reviewed with the Licensee, Carmen Flores.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC809 (FAS) - (06/04)
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