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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406217410
Report Date: 04/13/2026
Date Signed: 04/13/2026 11:28:13 AM

Document Has Been Signed on 04/13/2026 11:28 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:HERNANDEZ-MEDINA FCC AKA LITTLE BLESSINGS DAYCAREFACILITY NUMBER:
406217410
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ-MEDINA, MAYRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 710-7489
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/13/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Mayra Hernandez-MedinaTIME VISIT/
INSPECTION COMPLETED:
11:45 PM
NARRATIVE
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On 4/13/26, at 9:30 AM, Licensing Program Analyst (LPA) Matthew Sapien conducted an unannounced annual random inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Mayra Hernandez-Medina, Licensee of the FCCH, and explained the nature and purpose of the inspection. The LPA, in the company of Licensee, toured the FCCH in its entirety (inside and outside). The FCCH is a 4-bedroom and 2-bathroom single story dwelling. The areas that are accessible for care children are as follows: front room, dining room (main play area), one bathroom, and most of the backyard. The remainder of the home is excluded from childcare services, including all of the bedrooms. In the home, inaccessible areas and rooms are made secure by gates and locks. At the time of the inspection, LPA observed 10 children present, 3 of which were infants. At 10:31 AM, an additional child arrived at the FCCH tallying 11 children. Besides the Licensee, LPA observed two adults in the home at the time of the inspection (Licensee's husband who is cleared and associated and Licensee's adult biological child who is visiting the area). The Licensee's adult biological child also had two children of her own present, each 12 years old.

LPA observed the FCCH to be clean and orderly. The bathroom, utilized for childcare, is clean and free of toxins. LPA observed cleaning supplies in the laundry room in elevated areas. This area is off limits for children in care. Medications are stored in an elevated kitchen cabinet. No children currently require medication. Sharps are also stored in the kitchen in cabinet. This kitchen is made inaccessible with child safety gates.

LPA observed age-appropriate toys, furnishings, and equipment throughout the indoor spaces for the day care. LPA observed two electric fireplace in the home that are each enclosed by glass. Licensee attested to LPA that the fireplace is not used during day care hours. Licensee attested to LPA that there is one dog present within the residence. The dog does not have interactions with children in care, however, is current on their vaccines. LPA observed relevant licensing forms and documents posted prominently to a wall in the main day care room. In the hallway near the kitchen area, LPA observed a separate carbon monoxide and smoke detector. The carbon monoxide detector was tested at 10:15 AM and was found to be operational. The smoke detector was tested at 10:25 AM and was found to be operational. LPA observed a regulation fire extinguisher in the FCCH which was last serviced on 4/11/24. 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 4/13/26. Licensee informed LPA that drills are conducted every six months. (CONT. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Matthew Sapien
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2026
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: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSINGS DAYCARE
FACILITY NUMBER: 406217410
VISIT DATE: 04/13/2026
NARRATIVE
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As aforementioned, the backyard is accessible to children in care. The FCCH's outdoor area is enclosed by wooden fencing and chain linked fencing. As is the case with the interior of the FCCH, the outdoor area has age-appropriate play structures, toys, and other equipment throughout the area that can afford for robust 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 concrete pavement, natural grass, vinyl flooring, and dirt. Shade is afforded by neighboring trees, house overhangs, and a canopy. LPA observed no bodies of water on site and confirmed that this was the case with the Licensee. At a point, the Licensee did a covered and weighted jacuzzi, however, this was removed from the property in May of 2025. The Licensee attested to LPA that children are always supervised when engaged in outside activity. LPA advised the Licensee to inspect the outdoor area prior to letting children outside to ensure safety of children in care. Licensee also attested that the day care utilizes nearby Apple Valley Park. There is a gate in the backyard that provides entry to the park.

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. Licensee completed their Mandated Reporter training on 8/29/23 and Pediatric CPR/First Aid training (EMSA approved) on 2/26/24. 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 currently 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. Through interview and record review, the Licensee checks and documents napping infants every 15 minutes. 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. (CONT. 809-C, Page 3)

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

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
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: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSINGS DAYCARE
FACILITY NUMBER: 406217410
VISIT DATE: 04/13/2026
NARRATIVE
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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 inspection, three Type B citations were issued (see LIC 809-D pages).

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 4/13/26.

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, Mayra Hernandez-Medina.

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

DATE: 04/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/13/2026 11:28 AM - It Cannot Be Edited


Created By: Matthew Sapien On 04/13/2026 at 10:59 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: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSINGS DAYCARE
FACILITY NUMBER: 406217410

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Licensee's extinguisher expired on 4/11/24.
POC Due Date: 04/27/2026
Plan of Correction
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The Licensee must complete their training on or before 4/27/26 and send to the Department.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Licensee's abovementioned training expired on 2/26/26.
POC Due Date: 04/27/2026
Plan of Correction
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The Licensee must complete their training on or before 4/27/26 and send to the Department.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Matthew Sapien
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2026


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 04/13/2026 11:28 AM - It Cannot Be Edited


Created By: Matthew Sapien On 04/13/2026 at 10:59 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: HERNANDEZ-MEDINA FCC AKA LITTLE BLESSINGS DAYCARE
FACILITY NUMBER: 406217410

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/13/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. The Licensee's abovementioned training expired on 2/26/26.
POC Due Date: 04/27/2026
Plan of Correction
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The Licensee must complete their training on or before 4/27/26 and send to the Department.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Matthew Sapien
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2026


LIC809 (FAS) - (06/04)
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