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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216160
Report Date: 06/27/2023
Date Signed: 06/27/2023 04:59:14 PM

Document Has Been Signed on 06/27/2023 04:59 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
426216160
ADMINISTRATOR:MARYPAZ PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 863-3416
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 32CENSUS: 14DATE:
06/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:21 PM
MET WITH:Mary Paz PerezTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced inspection with Mary Paz Perez, licensee, Dulce Livier Escobar-Aguilar, Assistant, and Dulce Athziri Garduno Escobar, assistant, who arrived to the FCCH at 11:27am, to initiate a complaint investigation.

LPA observed at the time of arrival LPA observed 13 children and 1 infant playing the day-care room. LPA observed two (2) pack N plays with the mattress permanently raised above the foundation of the pack N play. LPA observed C15 in a pack N play with the mattress permanently raised above the foundation of the pack N play. LPA observed three additional pack N plays in the day-care room.

LPA observed Dulce Livier Escobar-Aguilar, assisting with the day-care children at the time of the inspection. LPA requested the assistance name, reviewed the facility roster, LIS, Guardian, which revealed that Dulce Livier Escobar-Aguilar, was not associated to the FCCH license. Licensee and assistant stated that assistant has been employed at the FCCH since June 2022.

A tour of home revealed that there are no toxins in the cabinets of the bathroom or kitchen today. A tour of the play yard reveals that there are no bodies of water. LPA observed that the licensee has two (2) indoor dogs. The licensee stated there are no guns and /or ammunition in the home.

Today’s visit was conducted in Spanish. 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 LIC 809 and LIC 809 D.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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 06/27/2023 04:59 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/27/2023 at 03:43 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2023
Section Cited
CCR
102370(d)(1)

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 The following CCR, Title 22, Division 12 regulation was cited: 102370 (d)(1) Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption....
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Ms.Dulce Livier Escobar-Aguilar mst get a criminal record clearance and submit all documents to the Community Care Licensing (CCL by 6/28/2023. A $500 civil penalty was assessed
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Department or This requirement is not met as evidence by: Based on LPA's review of the facility, interviews, the licensee and Ms. Escobar-Aguilar, stated that Ms. Escibar-Aguilar, has been assisting in the FCCH since June 2022, and has not obtained a criminal record clearance. This poses an immediate 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: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/27/2023 04:59 PM - It Cannot Be Edited


Created By: Martina Jimenez On 06/27/2023 at 04:11 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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 426216160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/06/2023
Section Cited
CCR
102423(a)(2)

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Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: To
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Licensee removed the two (2) pack N plays with the mattress permanently raised above the foundation of the pack N play from the FCCH, during the inspection.
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receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidence by: LPA observed C15 in a pack N play with the mattress permanently raised above the foundation of the pack N play. This poses an potential Health and Safety risk to 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: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023


LIC809 (FAS) - (06/04)
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