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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213003
Report Date: 08/05/2025
Date Signed: 08/05/2025 05:31:05 PM

Document Has Been Signed on 08/05/2025 05:31 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:MENDEZ FAMILY CHILD CAREFACILITY NUMBER:
426213003
ADMINISTRATOR/
DIRECTOR:		MARIA MENDEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 348-9266
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/05/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Maria MendezTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On 8/05/2025 at 2:45 PM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an unannounced Required Annual inspection at the above-mentioned facility. The LPA met with Maria Mendez, Licensee of the FCCH and explained the nature, scope, and purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. This is a three (3) bedroom, two (2) bathroom, single-story home with garage.

The licensee states that children have access to the living room, dining room, kitchen, bathroom located at the back of the home just past the dining room, and backyard. Meanwhile the rest of the home is excluded from childcare. At the time of the inspection, eleven (11) children are present with one (1) assistant (S1). LPA notes S1 is licensee’s spouse. Additionally, two children are infants. LPA observed a gate at the entrance of the hall preventing access to the bedrooms and garage. Additionally, the doors have safety doorknob covers preventing access.

The home was clean, orderly, with plenty of ventilation to afford for the children’s comfort and safety. Further, the home was void of hazardous items.

· At 3:26 PM the LPA tested smoke and a carbon monoxide detector and found both to be functioning.
· Required forms are posted on the wall in the back living room and not readily visible.
· The home has a regulation fire extinguisher with a service date 8/14/2024. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually.
· The home maintains working telephone services by way of cell phone.
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2025
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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Document Has Been Signed on 08/05/2025 05:31 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 08/05/2025 at 04:03 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: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in [1] out of [1 count] of changes to the home with ut notifying the Department which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/14/2025
Plan of Correction
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The Licensee will send an updated LIC279 and include the changes on the LIC999 to the LPA. The licensee will include a POC letter stating how she will in the future remeber to notify the department prior to making changes to the FCCH.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Joaquin Mendez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2025


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: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213003
VISIT DATE: 08/05/2025
NARRATIVE
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· Medication in the home is stored in and inaccessible to children in care.
· Knives are stored in an elevated locked cabinet and inaccessible.
· Toys, furniture, and equipment observed in the home are safe, varied and were age appropriate.
· LPA notes the original bathroom in the hall which was inspected at pre-licensing is no longer used. The bathroom used today is located in the back of the home just past the dining room and leading to the back yard, The licensee did not notify the Department of changes and Type B deficiency is cited (see LIC809D). LPA inspected the new bathroom and did not find any hazardous items which could pose harm to children. This bathroom used to have the washing machines which are now moved to an inaccessible area of the home. The licensee states no construction was done to the room. Instead, the already existing water lines are used to connect a sink and toilet for convenience use at the FCCH children.

The backyard was observed to be fenced with grass throughout, surrounding the play structures.
· The LPA observed plenty of shade provided by the provider on this warm afternoon.
· The LPA observed toys and items readily available for children and in good condition. The licensee is reminded to make constant checks to toys and play structures prior to allowing children access.
· There are no bodies of water observed.
· There are two separate areas in the backyard area that are inaccessible to children. 1) Area is for the family pet (a small dog sixteen years old) and the laundry machines. The second area is secure, and inaccessible where the family stores tools and other equipment.

LPA reviewed children’s records and were found to be missing completed forms. (see LIC9102).
· C1 and C2 are missing the LIC9227.
· Facility roster is observed.

The Licensee records were reviewed as noted below.
· CPR and First Aid certifications expire on 11/2026.
· Mandated Reporter Certification which expires on 6/28/2026.
· Fire drill last conducted 3/19/2025.
· The Licensee stated there are no firearms or ammunition in the home.
No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers,
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213003
VISIT DATE: 08/05/2025
NARRATIVE
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No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Licensee Maria Mendez was reminded that all adults 18 and over living or working in the home, 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.



Licensee states she does not provide Incidental Medical Services (IMS). 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 Child Care Centers 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-andresources/safe-sleep, as an additional resource. 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.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

During the exit interview, the Licensee Maria Mendez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile on 8/4/2025 in FAS.
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
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: MENDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426213003
VISIT DATE: 08/05/2025
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

There is a type B deficiency, and an LIC9102 technical violations cited during today’s inspection. (see attached LIC809D and LIC9102 respectively). Plan of Corrections (POC) will be submitted by licensee to LPA Mendez via email by the end of business day 8/14/2025.

Exit interview conducted and report was reviewed with the licensee Maria Mendez in her preferred language, Spanish.

A notice of site visit was given to Licensee Maria Mendez and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
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