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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 04/24/2025
Date Signed: 04/24/2025 02:14:18 PM

Document Has Been Signed on 04/24/2025 02:14 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CORREA FCC AKA ALYSSA'S CHILD CAREFACILITY NUMBER:
426216168
ADMINISTRATOR/
DIRECTOR:		ALYSSA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 966-1964
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 33CENSUS: 12DATE:
04/24/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Alyssa Correa TIME VISIT/
INSPECTION COMPLETED:
02:10 PM
NARRATIVE
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On April 24, 2025 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with licensee Alyssa Correa and informed them the purpose of the inspection. LPA notes the Stipulation Waiver, and Order CDSS No. 6423215102 states 1) Revocation: Stayed with Probation: Respondent's license is revoked upon the Department's adoption of the Stipulation as its Order. The revocation of the license shall be STAYED, for three (3) years during which the Respondent shall be granted probationary license subject to the limitations and conditions of the Stipulation and Waiver Order dated August 2, 2024. At the time of inspection 12 children and 1 assistant were present.

LPA arrived to the facility at approximately 10:25 AM. LPA rang the ring doorbell and waited, however no one came to answer the door. LPA did not observe any children at that time. LPA returned to take a picture of the business card left on the door and LPA observed there was children in the backyard of the home. Licensee stated they did not open the door because they did not hear the doorbell ring and showed LPA they usually use the other doorbell for the home. 1 Technical Violation was issued as a result.

LPA reviewed posted documents/forms and notes required documents/forms are posted on the wall in the day care room. LPA observed the Decision and Order CDSS No. 6423215102, which is located on a wall in the children's area , which is visible to parents who enter the day care room. LPA reminded licensee parents must be allowed in the day-care children areas at their request.

LPA observed the home to be clean and orderly. LPA observed the children's area to have plenty of space for children in care. LPA observed the kitchen and rest of the home is made inaccessible to children with a gate.
CONTINUED PAGE 2
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168
VISIT DATE: 04/24/2025
NARRATIVE
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LPA observed the fire place to be made inaccessible with a gate that is secured to the ground. LPA observed the assistant present to have a Criminal Record Clearance. LPA reviewed files of the children present. LPA observed most of the forms in all children's files, including the Acknowledgment of Receipt of Licensing Reports (LIC 9224), were missing dates of when they were signed. 1 Technical Violation was issued as a result. LPA observed the Safe Sleep 15 minute checks last entry to be 4/8/25. Licensee stated the 2 infants present today have not been present since 4/8/25. LPA observed staff files to be complete. LPA observed the assistant present to have a Mandated Reporter Certificate that expired 4/5/2025. 1 Type B deficiency is being issued as a result. LPA observed licensee and assistant to have current Pediatric CPR/First Aid (licensee expires 6/9/26, assistant expires 4/13/2027).

During today's inspection 1 Type B deficiency and 2 Technical Violations were issued.

Exit interview was conducted and report was reviewed with licensee Alyssa Correa. Notice of site visit and appeal rights were given.
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/24/2025 02:14 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 04/24/2025 at 01:31 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: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2025
Section Cited
HSC
1596.8662(b)(1)

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Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated ..., and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Licensee will have assistant complete the Mandated Reporter training and provide a copy of the certificate to LPA no later than 5/1/2025. Licensee will provide certificate to LPA via email at giovani.gonzalez@dss.ca.gov.
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This requirement is not met as evidenced by:

Based on record review, the licensee did not comply with the section cited above in not having a current Mandated Reporter certificate for their assistant (expired 4/5/25) which poses a potential health, safety 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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Giovani Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2025


LIC809 (FAS) - (06/04)
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