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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 05/26/2022
Date Signed: 05/26/2022 01:46:39 PM

Document Has Been Signed on 05/26/2022 01:46 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: 10DATE:
05/26/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Alyssa CorreaTIME COMPLETED:
01:50 PM
NARRATIVE
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On 05/26/2022 at 12:5 Licensing Program Analysts, (LPAs) Gigi Reyes and Rosie Breault conducted an unannounced Case Management inspection and met with Licensee, Alyssa Correa and Assistant Ashley Correa. LPAs explained the purpose of the inspection. LPAs asked pre-screening questions related to COVID - 19 and based on assistant's responses there was no COVID -19 exposure on site. LPAs observed 10 children present. One child was brought to school by another assistant, Jessica Garcia

During inspection, LPAs conducted file review of the Staff file. It was observed that Staff 1 does not have Mandated Reporter Training per AB 120., Staff 1 and Staff 2 do not have LIC 9052 Employee Rights, and LIC 508 Criminal Record Statement on file.

Licensee stated she has the LIC 9052 and LIC 508 for S1 and S2 in electronic file. However, the computer was not available to review the above mentioned documents.

During today's inspection, deficiencies were cited under Title 22 Division 12 of California Code of Regulation and Health and Safety Code.

Report was reviewed and discussed with Licensee, Alyssa Correa.

Notice of Site Visit was posted. Exit interview was conducted with Licensee, Alyssa Correa.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2022
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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Document Has Been Signed on 05/26/2022 01:46 PM - It Cannot Be Edited


Created By: Gigi Reyes On 05/26/2022 at 12:35 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: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2022
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care....This requirement was not met as evidenced
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Licensee agreed for Staff 1 to take the training and submit proof to CCL no later than June 6, 2022. Francisca.Velazquez@dss.ca.gov
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Based on File review and interview conducted, Staff has not taken the Mandated Reproter Training, per AB 1207. This poses a potential risk to health and safety of children in care.
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Type B
06/06/2022
Section Cited
CCR102370(c)

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(c) All individuals subject to a criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508.. This requirement was not met as evidenced by:
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Licensee will have S1 and S2 signed LIC 508 and submit copy to CCL on later than June 6, 2022
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Based on file review Staff 1 and Staff 2 do not have on LIC 9052 on file. Licensee stated LIC 508 is filed electronically however, computer was not available to review the documents. This poses a potential 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:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/26/2022 01:46 PM - It Cannot Be Edited


Created By: Gigi Reyes On 05/26/2022 at 12:55 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: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2022
Section Cited
CCR
102416(a)

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102416 Personnel Requirements
(a) The licensee shall provide each employee with a copy of the Notice of Employee Rights (LIC 9052 (4/88).. This requirement was not met as evidenced by:
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Licensee agreed to provide LIC 9052 Notice of Employee Rights to S1 and S2 and submit plan of correction no later than 6/6/2022.
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Based on file review the LIC 9052 was not found on file. Licensee stated it was electronically filed but computer was not available. This poses a potential 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:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022


LIC809 (FAS) - (06/04)
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