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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 03/09/2023
Date Signed: 03/09/2023 12:04:00 PM

Document Has Been Signed on 03/09/2023 12:04 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:
03/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Alyssa CorreaTIME COMPLETED:
12:15 PM
NARRATIVE
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On 3/9/23, at 10:30 AM, Licensing Program Analyst (LPA) Francisca Velazquez made an unannounced Case Management- Deficiencies inspection at the Family Child Care Home (FCCH). LPA met with Alyssa Correa, Licensee of the FCCH explained the nature of the inspection. LPA note eight children are present along with Licensee.

The Case Management inspection is to document the FCCH out of capacity during time of inspection. At arrival, LPA observed Licensee providing care and supervision to eight (8) children all under the age of five.

Today, Type A deficiency is being 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



A closing interview and review of report was conducted with Licensee, Alyssa Correa in Spanish and a Plan of Correction was discussed. Licensee was provided and advised of Appeal Rights. Licensee's signature at the bottom of this report acknowledges Licensee received the reports and understand their rights.

The Notice of Site Visit was also provided to the Licensee as required by H&S Code Section 1596.817. The Notice of Site Visit must remain posted for 30 days or a civil penalty of $100.00 may apply.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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 03/09/2023 12:04 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 03/09/2023 at 11:05 AM
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: 03/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/10/2023
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 follow the capacity of a Small Child Care License when licensee does not have assitant. Licensee will write and submit a written statement detailing how she will ensure that capacities are met at all times.
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At arrival, LPA observed Licensee providing care and supervision to eight (8) children all under the age of 5 years without an assistant. This is an immediate risk to the 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:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023


LIC809 (FAS) - (06/04)
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