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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208978
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:31:42 PM

Document Has Been Signed on 09/06/2023 04:31 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:PADILLA FCC AKA MI CASA LA CIGUENAFACILITY NUMBER:
426208978
ADMINISTRATOR:MARIA PADILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 478-3338
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
09/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Maria PadillaTIME COMPLETED:
04:45 PM
NARRATIVE
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On 09/06/2023, Licensing Program Analyst (LPA) Francisca Velazquez made an unannounced Case Management inspection at the Family Child Care Home (FCCH). LPA met with Maria Padilla, licensee of the FCCH and explained the nature of the inspection. LPA note seven (7) children are present along with licensee and assistant. LPA an licensee conducted a tour of the interior and exterior of the FCCH.

The Case Management inspection follows an unannounced inspection at the FCCH for the purpose of documenting deficiency observed during today's inspection.

While interviewing licensee and assistant, it was revealed that licensee had an assistant, Maricela Tinoco that worked in the FCCH from about mid February of 2023 until about June 10, 2023. LPA notes, this adult is not and was not fingerprint cleared at this FCCH. Per licensee, this adult is no longer employed at this FCCH.

During today's inspection, deficiency is being cited.

Today, deficiency cited under Title 22 Division 12 Appeal rights given. 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.

Exit interview and review of report was conducted in Spanish by LPA Velazquez with licensee, Maria Padilla. Notice of site visit and appeal rights were provided to licensee.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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Document Has Been Signed on 09/06/2023 04:31 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 09/06/2023 at 03:51 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: PADILLA FCC AKA MI CASA LA CIGUENA
FACILITY NUMBER: 426208978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/07/2023
Section Cited
CCR
102416(d)

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Personnel Requirements: (d) Prior to employment or initial presence in the child care home, all employees and volunteers subject to a criminal record review shall: This requirement was not met as evidence by:
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Licensee agrees to submit written statement detailing how she will ensure that all adults present in the home have received a criminal record clearance prior to being present in the home by 09/07/23 to Francisca.Velazquez@dss.ca.gov
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While conducting Licensee interview, it was revealed that licensee had an assistant that worked in the FCCH from mid Febuary 2023 until about June 10, 2023 without criminal record clearance which poses an immediate risk to the health, safety and personal rights 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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


LIC809 (FAS) - (06/04)
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