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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 07/29/2022
Date Signed: 07/29/2022 02:46:06 PM

Document Has Been Signed on 07/29/2022 02:46 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: 8DATE:
07/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alyssa Correa TIME COMPLETED:
03:00 PM
NARRATIVE
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On 7/29/2022, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced inspection to the facility for the purpose of concluding a complaint investigation. This report is to document deficiencies observed during inspection. LPA meet with Adelaida Santos Churape, Assistant of the facility and explained the purpose of this inspection.

At arrival Assistant, Adeliada Santos Churape reported supervising eight (8) children while Licensee went to the store to get milk. After conducting record review of all children present in the facility, it is determined the Licensee was out of capacity. There are four (4) infant age children and four (4) children between the ages of 2 through 4 year old being supervised by Assistant.

LPA notes that Licensee arrived about 10 minutes after LPA initiated this visit. Licensee reported that she went to go get milk for the children. Licensee stated having knowledge that there can only be up to two (2) infants when there is only one adult providing care and supervision.

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. This inspection and revision of report was conducted in Spanish due to Spanish being Licensee's primary language.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 07/29/2022 02:46 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 07/29/2022 at 02:10 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: 07/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/01/2022
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 reports understanding ratios and states that she thought it was easy to just go to the store. Licensee agrees this is not acceptable. License will avoid leaving the facility and will start to use Door-Dash services if the facility ever needs anything from the store during day-care hours. Licensee agrees to submit written plan to LPA via email to
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During today's inspection, based on LPAs observations, Assistant, Adelaide was providing care and supervision to eight (8) children (4 infants and 4 children between the ages of 2-4). This is an immediate risk to the health and safety of the children.
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Francisca.Velazquez@dss.ca.gov by 8/1/22 (next business day).

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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: 07/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2022


LIC809 (FAS) - (06/04)
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