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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 05/17/2022
Date Signed: 05/17/2022 05:03:30 PM

Document Has Been Signed on 05/17/2022 05:03 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:CORREA FCC AKA ALYSSA'S CHILD CAREFACILITY NUMBER:
426216168
ADMINISTRATOR:ALYSSA CORREAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 966-1964
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
05/17/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alyssa CorreaTIME COMPLETED:
05:01 PM
NARRATIVE
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On 05/17/2022 at 12:00 pm, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Proof of Correction (POC) Inspection at the above Family Child Care Home (FCCH). The purpose of this report is to document deficiencies observed during inspection. LPA asked pre-screening questions related to COVID - 19 and based on licensee's responses it was determined that the home was safe and free of any COVID -19 exposure on site.

When LPA arrived at the home, LPA observed Licensee and Assistant, Jessica Garcia in the front yard of the home by a white mini-van. LPA observed that Assistant was sitting in the driver’s seat and Licensee was standing outside the van. Assistant then drove off in the white van and Licensee entered the home.

Upon entering the home, LPA observed Licensee supervising eleven (11) children. Licensee stated that assistant is dropping off one (1) child at school. LPA notes that assistant, returned to the home at 10:42 am.

At 10:31 am, LPA observe a baby bottle in a crib.

At 10:45 am, LPA requested children files for review. LPA notes that out of the eleven (11) children present, four (4) children did not have a file at all readily accessible for review. Out of the seven (7) files that Licensee had readily accessible for review, four (4) did not have immunizations. LPA notes that all infant files did not have 15 minute safe sleep log. Licensee stated that she is not documenting 15 minute safe sleep checks because all the infants enrolled are rolling over. LPA clarified that all children under the age of 2 years need to have a 15 minute safe sleep log. CONT 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORREA FCC AKA ALYSSA'S CHILD CARE
FACILITY NUMBER: 426216168
VISIT DATE: 05/17/2022
NARRATIVE
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The following deficiencies were cited during today’s inspection and are documented in LIC 809-D: CCR 102416.5, CCR 102425(b), CCR 102425(j)(d) and CCR 102421.

Today, deficiency cited under Title 22 Division 12, Appeal rights were given in Spanish.

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.



Exit interview and review of report was conducted in Spanish, as Spanish is the first language of Licensee, Alyssa Correa.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 05/17/2022 05:03 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 05/17/2022 at 03:18 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: 05/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2022
Section Cited
CCR
102416.5

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102416.5 Staffing Ratio and Capacity
(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. This requirement was not met as evidence by:
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Licensee agrees to review the chid care video regarding staffing and ratios and submit in writing her understanding of ratios and capacity for large family child care license. Licensee agrees to submit this plan of correction via email to francisca.velazquez@dss.ca.gov by 5/18/22.
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During today's inspection, based on LPAs observations, Licensee was providing care for eleven (11) children during inspection. A;so upon arrival to the faciliy, Licensee was outside the home, meaning eleven (11) children were in the home without supervision. This is a repeat citation and an immediate risk to the health and safety of the children.
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Licensee is also interested in participating in the Technical Support Program (TSP) for guidance in Title 22.

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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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2022 05:03 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 05/17/2022 at 03:33 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: 05/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2022
Section Cited
CCR
102421

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102421 Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidence by:
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Licensee agrees to create children files for all children receiving services by 5/18/22 and submit pictures via email to francisca.velazquez@dss.ca.gov if Licensee does not have child file, Licensee states that she will not provide care to children until child's file is complete.
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Based on LPA observation during this inspection out of the eleven (11) children present, four (4) did not have a file to be reveiwed. Out of the seven (7) files avaialbe for review, four (4) did not have immunizations. This is a potential health and safety risk to the children in care.
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Type B
05/18/2022
Section Cited
CCR102425(b)

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102425 INFANT SAFE SLEEP (b) Cribs or play yards shall be free from all loose articles and objects. This requirement was not met as evidence by:
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Licensee agrees to attend an in-person safe sleep training provided by resource and referral witin two (2) weeks of today's inspection and submit proof of attendance via email to francisca.velazquez@dss.ca.gov
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Based on LPA observation during inspection, there was an empty baby bottle in the crib. LPA notes no infant was inside the crib. This is a potential health and safety risk to the 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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/17/2022 05:03 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 05/17/2022 at 03:41 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: 05/17/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/18/2022
Section Cited
CCR
102425(j)(d)

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(j) The provider shall supervise infants while they are sleeping and adhere to the following requirements: (D)Documentation shall be maintained in the infant’s file...for review. Documentation shall include the following: a. Date b. Infant’s name c.Time of each 15-minute check. This requirement is not met as evidence by:
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Licensee agrees to start documeting 15 mintue checks for all children under the age of two (2) years and will send tracking sheet via email to francisca.velazquez@dss.ca.gov by 5/918/22
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During today's inpsection, Licensee stated understanding that documentation did not need to occur if infant is already rolling. Per Licensee, infants are rolling and therefore documentation is not occuring. This is a potential risk to the health and safety of the 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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022


LIC809 (FAS) - (06/04)
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