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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215565
Report Date: 11/06/2024
Date Signed: 11/06/2024 11:04:34 AM

Document Has Been Signed on 11/06/2024 11:04 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CHACON FAMILY CHILD CAREFACILITY NUMBER:
426215565
ADMINISTRATOR/
DIRECTOR:		EDIS Y. CHACONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 636-3211
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Edis ChaconTIME VISIT/
INSPECTION COMPLETED:
11:19 AM
NARRATIVE
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On November 06 2024, Licensing Program Analyst (LPA) Susana Martinez made an unannounced visit for the purpose of conducting a Case Management- Deficiencies inspection to discuss violation observed during an inspection to initiate a complaint. LPA met with Edis Chacon, Licensee, and advised the purpose for the inspection. LPA toured the home inside and outside. At the time of inspection there were six (6) children along with Licensee and assistant.

As LPA toured the children's bathroom LPA observed a 6 oz bottle of "portable spot cleaner" located under the bathroom sink which was observed to be unlocked and easily accessible to children. A child (C1) followed Licensee and LPA into the bathroom and was observed to step into the cabinet located under the bathroom sink. LPA asked Licensee what the bottle was, Licensee stated she thought it was a soap. LPA advised Licensee to look at the label located on the back of the bottle which reads (in both English and Spanish): "KEEP OUT OF REACH OF CHILDREN". LPA reminded Licensee to read labels to determine if they are safe to keep around children. In the bathroom shower, LPA also observed bath soaps including shampoos.

During the inspection LPA asked for a copy of the children's roster. Licensee handed roster to LPA. LPA asked to identify all the children in care. It was determined that three (3) out of the six (6) children were not listed on the roster. Licensee completed the roster during the inspection.

One Type B deficiency for CCR 102417 Operation of a Family Child Care Home(g)(4) and one technical violation for the incomplete children's roster was issued during today's inspection.

Notice of site visit was issued and should remain posted for 30 days.
Exit interview conducted, appeal rights were given, and report was reviewed in Spanish with Licensee Edis Chacon.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 11/06/2024 11:04 AM - It Cannot Be Edited


Created By: Susana Martinez On 11/06/2024 at 10:35 AM
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: CHACON FAMILY CHILD CARE
FACILITY NUMBER: 426215565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2024
Section Cited
CCR
102417(g)(4)

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102417Operation of a Family Child Care Home(g) The home shall be free from defects or conditions which might endanger a child...shall include but not be limited to:(4)Poisons, detergents, cleaning compounds, medicines, firearms...which could pose a danger... shall be stored where they are inaccessible to children. This requirement was not met as evidence by:
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Licensee removed the cleaning compounds to inaccessible areas during the inspection. Licensee is to write a written statement on how she will prevent this deficiency from re-occuring.
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Based on observation and interview, cleaning compunds and shampoos are accessible to children in care which poses a potential Health and/or, Safety and/or, Personal Rights risk to persons 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:Ana Tolentino
LICENSING EVALUATOR NAME:Susana Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


LIC809 (FAS) - (06/04)
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