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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208696
Report Date: 02/25/2022
Date Signed: 02/25/2022 03:35:53 PM

Document Has Been Signed on 02/25/2022 03:35 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:NAVARRO FAMILY CHILD CAREFACILITY NUMBER:
426208696
ADMINISTRATOR:MARIA NAVARROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 345-1927
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
02/25/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria Navarro TIME COMPLETED:
02:33 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

Licensing Program Analyst (LPA) Martina Jimenez made an unannounced Collateral visit. to interview children in care. A Case Management - Deficiency was identified during the inspection. LPA met with Licensee, Maria Navarro, and Columba Antonio Martinez. The purpose of the inspection was discussed and together toured the facility inside and out. LPA observed 4 children in care at the time of the inspection.

At approximately 12:15PM, LPA observed licensee in the kitchen preparing lunch for the children in care. LPA asked the licensee if licensee was caring for children. The licensee stated yes. LPA requested the licensee escort LPA to the location where the day-care children were located in the Family Child Care Home. Licensee escorted LPA to the backyard. LPA observed Ms. Martinez alone in the backyard with the 4 day-care children.

LPA interviewed licensee and Ms. Martinez. During the interviews it was confirmed that Columba Antonio Martinez, assist in the FCCH 1-2 times a week since January 2022. Ms. Martinez does not have a criminal record clearance to assist in the home.

LPA provided licensee with documentation regarding Criminal Record Clearance. The following CCR, Title 22, Division 12 regulation was cited: 102370 (d)(1) Criminal Record Clearance. Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696
VISIT DATE: 02/25/2022
NARRATIVE
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Today, deficiency cited under Title 22 Division 12, Appeal rights were provided in Spanish.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.



One type A deficiency and a $500 civil penalty was cited today: Posting Requirement. Today’s visit was conducted in Spanish by LPA Jimenez

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022
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Document Has Been Signed on 02/25/2022 03:35 PM - It Cannot Be Edited


Created By: Martina Jimenez On 02/25/2022 at 02:20 PM
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: NAVARRO FAMILY CHILD CARE
FACILITY NUMBER: 426208696

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2022
Section Cited
CCR
102370(d)(1)

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 The following CCR, Title 22, Division 12 regulation was cited: 102370 (d)(1) Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption....
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Ms. Columba Antonio Martinez must get a criminal record clearance and submit all documents to the Community Care Licensing (CCL). A $500 civil penalty was assessed
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Department or This requirement is not met as evidence by: Based on LPA's review of the facility and interviews, the licensee and Ms. Martinez, stated that Ms. Martinez assist in the FCCH 1-2 times a week since January 2022, and has not obtained a criminal record clearance. This poses an immediate risk to health and safety of 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:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022


LIC809 (FAS) - (06/04)
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