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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216168
Report Date: 08/14/2023
Date Signed: 08/14/2023 01:11:19 PM

Document Has Been Signed on 08/14/2023 01:11 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: 13DATE:
08/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
06:40 AM
MET WITH:Alyssa CorreaTIME COMPLETED:
01:30 PM
NARRATIVE
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On 08/14/2023 at 6:40 AM Licensing Program Analyst, (LPA) Francisca Velazquez conducted an unannounced Case Management Proof of Correction (POC) Inspection at the Family Child Care Home (FCCH) and met with Licensee, Alyssa Correa. LPA explained the purpose of the inspection. LPA observed 13 children being cared by Licensee. LPA notes that at time of LPA’s arrival, two (2) assistants arrived at the FCCH. Licensee reported that prior to assistants arriving at the FCCH, Licensee was the only adult providing care and supervision to the 13 children.

At 6:42 AM, LPA observed two (2) infants sleeping on a couch. LPA observed eleven (11) children in the daycare room in various stages of sleep. LPA notes that all children present at the FCCH did not have proper napping equipment as some children laid directly on the floor and infants under the age of one year were observed sleeping in couches or cots.

On 08/01/2023 the Licensee/FCCH was cited of the following Type A deficiencies:
1. 102417(g)(3) - The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded. During today’s inspection, LPA observed the gate on the bottom step of the home to be locked and secured. In addition, Licensee submitted written statement on 08/02/2023 detailing how she will ensure that stairway is always inaccessible to children. This deficiency has been cleared.

2. 102425(h) - Car seats shall only be used for transportation purposes and shall not be used for sleeping. On 08/02/2023, Licensee submitted written statement detailing that she understands infants can not sleep in car seats and must sleep in appropriate napping equipment. During today’s inspection, LPA observed two (2) infants sleeping on the couch and three (3) infants sleep on cots. This deficiency is not cleared as it was a repeat deficiency during today’s inspection.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 08/14/2023
NARRATIVE
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3. 102370(d)(2) - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 102370(j). On 8/1/2023, Licensee submitted via email LIC 9182 Criminal Background Clearance Transfer Request along with picture ID of adult. This individual is now associated to this FCCH. This deficiency has been cleared.

4. 102416.5(a) - (a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. On 8/2/23, Licensee submitted POC via email detailing that she will operate within her ratios and capacity's. LPA observed Licensee providing care for 13 children without an assistant. This deficiency is not cleared as it was a repeat deficiency during today’s inspection.

5. 102423(a)(2) - Each child receiving services from a family childcare home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. LPA notes this POC was not received. Licensee reported that she got confused and instead of submitting a POC for personal rights, licensee submitted POC for lack of sleeping equipment available to children in care. During today’s inspection, licensee submitted written POC. LPA notes that during this inspection, LPA observed 11 children in various stages of sleep in the daycare room without appropriate sleeping equipment as some children laid directly on the floor. In addition, there was not enough staffing to provide care and supervision to the children present. This deficiency is not cleared as it was a repeat deficiency during today’s inspection.

On 08/01/2023 the Licensee/FCCH was cited of the following Type B deficiencies:

1. 102417(g)(9)(A)1 - The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (A) Each family childcare home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family childcare home. On 08/02/2023, Licensee submitted emergency drill log detailing last drill conducted occurred on 08/02/2023. This deficiency has been cleared.

CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
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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: 08/14/2023
NARRATIVE
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2. 1596.8662(b)(1) - (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 reporter training provided pursuant to paragraphs. During inspection on 08/01/2023, A1 and A2 did not have mandated reporter training certificate. On 08/02/2023, Licensee submitted proof of mandated reporter certificate completion for A2. This deficiency is not cleared as Licensee has not submitted proof of mandated reporter certificate completion for A1. During today’s inspection, licensee informed LPA that A1 has registered to take this course.

3. 102416.1(d) - All personnel records shall be maintained at the childcare home and shall be available to the licensing agency for review. During today’s inspection, LPA conducted record review of A1 personnel file and found A1 personnel file to not have mandated reporter training certificate, TB within one year of starting to work at the FCCH, LIC 9108 and flu waiver. A3 does not have LIC 9108 on file. This deficiency is not yet cleared.

4. 102418(g) - The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. During today’s inspection, LPA conducted child record review and found C3, C4, C7 did not have any immunizations on file, C8, C9 had a immunization summary but immunizations were not documented on immunization card. Lastly, C11, C12 and C13 did not have a child file to review during inspection. This deficiency has not been cleared.

5. 102417(g)(8) - Each family childcare home shall have a current roster of children as specified in Health and Safety Code Section 1596.84. On 08/02/2023, licensee submitted via email an updated copy of her facility roster. During record review today, LPA observed C10, C11, C12 and C13 were not documented in the facility roster. This deficiency has not been cleared.

6. 102425(c)(2) - An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. The Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be maintained in the infant’s file and shall be available to the Department for review. During record review, LPA observed C11 did not have LIC9227 completed in child file. This deficiency has not been cleared.
CONT 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
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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: 08/14/2023
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7. 102425(j)(2)(D)(c) - Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check. During record review, Licensee reported that C11 does not have documentation in regard to 15-minute checks. This deficiency is not yet cleared.

The following Type A deficiency are now cleared: CCR 102417(g)(3) and CCR 102370(d)(2). The following Type A are repeat deficiencies 102425(h), 102416.5(a) and 102423(a)(2).

The following Type B deficiency has now cleared: CCR 102417(g)(9)(A)(1). The following Type B are repeat deficiencies, HSC 1596.8662(b)(1), CCR 102416.1(d), CCR 102418(g), CCR 102417(g)(8), CCR 102425(c)(2), and CCR 102425(j)(2)(D)(c).

During record review, LPA reviewed LIC 9224 Acknowledgement of Licensing Reports are on children's file. LPA found that C3, C4, C5, C6 and C7 did not have any LIC 9224 in their child files. In addition, C1 and C2 only had one LIC9224 dated 08/01/2023. C10 had one LIC 9224 dated 7/29/22 and one LIC9224 that was not dated. Lastly, C8 and C9 had LIC 9224 for dates 5/6/22, 5/17/22 and two LIC9224 with no dates.

Today, deficiencies cited under Title 22 Division 12 Appeal rights given. Civil penalty was accessed. 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.

Exit interview and review of report was conducted in Spanish by LPA Velazquez with licensee, Alyssa Correa. Notice of site visit and appeal rights were provided to licensee.

CONT 809-D

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023
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Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 11:00 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2023
Section Cited
CCR
102425(h)

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Infant Safe sleep: Car seats shall only be used for transportation purposes and shall not be used for sleeping.
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Licensee agrees to place infants to sleep in the appropriate crib or playpen and will submit a written statement declaring how she will ensure to follwing this regulation at all times to Francisca.Velazquez@dss.ca.gov by 8/15/23.
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At 6:42am, LPA observed two (2) infants sThis requirement is not met as evidenced by: leeping on the couch with pillows and blankets. In addtion, LPA observed three (3) infants sleeping on cots which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
08/15/2023
Section Cited
CCR102416.5(a)

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(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 is not met as evidenced by:
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Licensee agrees to ensure that at least one assistant will start her work day earlier to ensure there is enough staff when children arrive. Licensee will submit update work schdules for all assistants that provide care and supervision to the children to Francisca.Velazquez@dss.ca.gov by 8/15/23.
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At 6:40am, LPA observed two (2) assistants arriving to the FCCH. During inspection, Licensee reported licensee was the only adult in the home providing care and supervison to 13 children until the two (2) assistants arrive which poses an immediate health, safety or personal righs 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


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Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 11:10 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2023
Section Cited
CCR
102423(a)(2)

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(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged... To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by:
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Licesee will ensure that the home is clean prior to any children arriving and will ensure there is enough accomodations for the children regardless of what the familiy requests. Licensee will submit written plan by 8/15/23 to Francisca.Velazquez@dss.ca.gov
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During inspection, LPA observed 13 children in various stages of sleep. LPA observed children did not have proper sleeping equipment as some children were laying directly on the floor. In addition, there was not enough staff to meet the basic needs 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: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


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Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 11:14 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2023
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 day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...This requirement is not met as evidenced by:
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Licensee has ensured that A1 has enrolled in taking AB1207 training. Licensee agrees to have a monthly checklist to ensure all certifcates are up to date. Licensee will submit written plan by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Record review revealed A1 still has not completed AB1207- Mandated Reporter Training Certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/21/2023
Section Cited
CCR102416.1(d)

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All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review. This requirement is not met as evidenced by
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Licensee agrees to update personnel records and will submit proof by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Recrod review revealed A1 has an incomplete personnel file at the FCCH. A1 is missing TB clearace within one year of working at the FCCH, AB1207, Flu waiver, LIC9108. A3 does not have TB clearance and LIC9108 which poses/posed 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


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Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 11:20 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2023
Section Cited
CCR
102418(g)

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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. This requirement is not met as evidenced by:
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Licensee agrees to review all child files and agrees to update all immunizations for all children. Licensee will email proof by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Record review revealed C3, C4, C7, C11, C12 and C13 does not have immunizations in the child's record for review. In addition C8 and C9 had an immunization summary but not an immunization card which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/21/2023
Section Cited
CCR102417(g)(8)

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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licensee agrees to update roster and document all new enrolled families prior to the first day of service. Licensee will submit updated roster by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Record review revelaed that C10, C11, C12 and C13 were not documented in the FCCH facility roster which poses/posed 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


LIC809 (FAS) - (06/04)
Page: 8 of 10
Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 11:26 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2023
Section Cited
CCR
102425(c)(2)

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An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age...LIC 9227 shall be maintained in the infant’s file and shall be available to the Department for review. This requirement is not met as evidenced by:
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Licensee will ensure all infants under the age of one have completed LIC9227. Licensee will submit proof of C11 LIC9227 by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Record review revealed C11 did not have LIC9227 Indiviudal Infant Sleeping Plan for review which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/21/2023
Section Cited
CCR102425(j)(2)(D)(c)

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check.
This requirement is not met as evidenced by:
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Licensee will ensure 15 mintue checks are being documented for all children under the age of two years and will submit proof via email by 8/21/23 to Francisca.Velazquez@dss.ca.gov
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Record review revealed, C11 does not have 15 minute check accessible for review which poses/posed 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2023 01:11 PM - It Cannot Be Edited


Created By: Francisca Velazquez On 08/14/2023 at 12:23 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: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2023
Section Cited
CCR
102419(j)

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Admission Procedures and Parental and Authorized Representative's Rights- (j) Copies of the signed receipt shall be available to the Department as provided in Section 102391(d). This requirement is not met as evidenced by:
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Licensee will ensure that all parents are notified when the FCCH receives any Type A deficiences or has any meeting in the regional office and will submit proof by 8/21/23 via email to Francisca.Velazquez@dss.ca.gov
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Record review revealed C3, C4, C5, C6, C7, C10, C11, C12 and C13 did not have LIC9224 for previous Type A deficienses cited at the FCCH. C8, C9 and C10 had LIC9224 on file with no dates which poses/posed 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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023


LIC809 (FAS) - (06/04)
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