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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426215565
Report Date: 12/03/2024
Date Signed: 12/03/2024 10:53:59 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/01/2024 and conducted by Evaluator Susana Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20241101113951
FACILITY NAME:CHACON FAMILY CHILD CAREFACILITY NUMBER:
426215565
ADMINISTRATOR:EDIS Y. CHACONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 636-3211
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY:14CENSUS: 6DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Edis ChaconTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee did not advise CCL of alterations to the home.
INVESTIGATION FINDINGS:
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On December 3, 2024 Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced inspection to deliver the findings of the above mentioned allegation. LPA met with Licensee, Edis Y. Chacon and advised her of the purpose for the inspection. Together with the Licensee, LPA toured the home. At the time of inspection there were 6 children in care of 2 adults.

The Department received an allegation indicating Licensee did not advise CCL of alterations to the home. The reporting party (RP) reports the construction activities occurred with children present in the construction zone. Furthermore, the RP indicated the shade structures were likely unpermitted and uninspected. The investigation included two unannounced inspections, LPA’s observations, and interviews with staff.


Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20241101113951
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CHACON FAMILY CHILD CARE
FACILITY NUMBER: 426215565
VISIT DATE: 12/03/2024
NARRATIVE
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Investigation revealed that Licensee did not report the alterations to CCL prior to commencing construction. Furthermore, Licensee states that the city conducted an inspection on 11/05/2024 and determined that a permit must be obtained for the patio shade and the storage sheds located in the outdoor children’s play area. Licensee admits she did not report it to CCL and denies having children present during construction.

Based on LPAs observations, interviews which were conducted, documents gathered and record review, the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED. One Type B deficiency for California Code of Regulations, Title 22, Division 12 section 102416.3(a), is being cited on the attached LIC 9099D.

California Code of Regulations Title 22, section 102416.3(a) requires licensees to notify their local Child Care Regional Office, prior to beginning any construction or making alterations to a licensed facility, a licensee is required to notify the Department of the proposed changes. This includes any change to the buildings or grounds that are part of the facility. In addition, for Family Child Care Homes the licensee shall provide the Department with a copy of an inspection report when an inspection is required by the local building inspector as a result of the alteration, addition or construction.

LPA provided a copy of PIN 23-20-CCP: Required Notifications Prior for Making Changes to Child Care Facilities.

A Notice of Site Visit (LIC 9213) and Appeal Rights (LIC 9058) were provided to Licensee. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may be applied.

Exit interview was conducted and report was reviewed in Spanish with Licensee Edis Y. Chacon.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20241101113951
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CHACON FAMILY CHILD CARE
FACILITY NUMBER: 426215565
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
102416.3(a)
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102416.3 Alterations to Existing Buildings 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:. This requirement was not met as evidence by:
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Licensee is to submit city permit approval and/or paperwork to the Department by 12/17/24. Licensee is to submit a written statment on how she plans to prevent this deficiency from re-occuring. Documents are due to LPA by 12/17/24 by mail or email. LPA provided contact information.
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Based on observation, interviews conducted, and record review, Licensee did not comply with the deficiency cited above as Licensee did not notify the Department of proposed changes which poses an a potential risk to the health, safety and or 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.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3