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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213887
Report Date: 11/02/2023
Date Signed: 11/03/2023 08:40:13 AM

Document Has Been Signed on 11/03/2023 08:40 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:SOTO FAMILY CHILD CAREFACILITY NUMBER:
426213887
ADMINISTRATOR:MARIA SOTOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 348-3517
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 6DATE:
11/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:14 PM
MET WITH:Maria Soto TIME COMPLETED:
07:30 PM
NARRATIVE
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On 11/2/2023 at 2:45 PM , Licensing Program Analyst (LPA) Martina Jimenez conducted unannounced Case Management inspection for the purpose of initiating a complaint investigation. LPAs met with Maria Soto, licensee and Jose Gomez, licensee's adult son. Licensee was advised the purpose of this inspection. LPAs observe six (6) children at the time of the inspection.

Based on the information provided by Maria Soto, licensee during investigation. The licensee stated that licensee had not reported the incident of a child wandering from the family child care on October 23, 2023. The licensee stated that she was hoping the licensing would not find out of the incident.

Licensee failed to notify CCLD of the incident that occurred on 10/23/2023, of a child leaving the family child care home with the licensee having no knowledge of C1's absence from the home and being unsupervised.

LPA Jimenez provided the licensee the unusual incident report (LIC624B) at the time of the inspection to complete and provide to LPA at the time of the inspection.

Exit interview conducted and report was reviewed with the licensee, Maria Soto.

Today’s visit was conducted in Spanish. Today, deficiency cited under Title 22 Division 12 Appeal rights given. THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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 11/03/2023 08:40 AM - It Cannot Be Edited


Created By: Martina Jimenez On 11/02/2023 at 06:44 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: SOTO FAMILY CHILD CARE
FACILITY NUMBER: 426213887

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2023
Section Cited
CCR
101212(d)(1)

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax...This requirement is not met as evidenced by:
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Licensee submitted the Unususal Incident Report Form to LPA on 11/03/2023. Licensee agreed to submit the UIR upon occurrence of the incident within 24 hours from the occurence of the incident
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Based on the record review and interview with Licensee, Licensee failed to report the said incident to the department. This poses a potential 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: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023


LIC809 (FAS) - (06/04)
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