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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216238
Report Date: 12/13/2024
Date Signed: 12/13/2024 12:01:12 PM

Document Has Been Signed on 12/13/2024 12:01 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
426216238
ADMINISTRATOR/
DIRECTOR:
DANA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 868-3653
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
12/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:48 AM
MET WITH:Dana DiazTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On December 13, 2024, @ 9:48 AM, Licensing Program Analyst (LPA) Joaquin Mendez, conducted an unannounced Inspection for the purpose of performing a required annual inspection. LPA met with Dana Diaz, Licensee. LPA explained the nature/purpose of the inspection.

LPA and Licensee together toured the interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit, which would pose a danger to the children in care. LPA observed four (4) children in care at the time of the inspection.

· LPA observed a regulation 2A10BC fire extinguisher in the FCCH which was serviced on April 2, 2024. Licensee is reminded to service or purchase the fire extinguisher yearly.

· Licensee tested the combination smoke and carbon monoxide detectors tested at 10:43am and were functioning at the time of the inspection.

· Licensee stated that there are no guns or ammunition in the home.

· Licensee stated she does not hold a foster family license.

LPA and applicant together toured the outdoor play area. There were no bodies of water observed at the time of the inspection. Applicant stated there are no bodies of water at the home. LPA advised the applicant children must never be unsupervised while the children are at the play area.

LPA reviewed children’s records and found them to be complete. LPA notes that when reviewing staff records, both staff are missing the LIC9052. Neither of the staff ware present at the time of inspection. A TA9102 Technical Assistant was provided to the licensee. Licensee record revealed all needed forms and certificates complete, and dates are noted below.

· The licensee Pediatric First Aid/CPR certificate is valid until November 7, 2025.

Continue on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 426216238
VISIT DATE: 12/13/2024
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· Licensee Mandated Reporter Training certificate is valid until November 14, 2025.

· The licensee provided proof of control of property. Control of property was verified via receipt of lease agreement.

· Because the applicant, rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continue on LIC809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 426216238
VISIT DATE: 12/13/2024
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Licensee does not provide Incidental Medical Services (IMS).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Dana Diaz, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 12/12/2024.

A Technical Assistance is being cited based on LPA observation, interview, and record reviews pursuant to Title 22 of the CA Code of Regulations LIC9102TV. Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Dana Diaz in the preferred language, Spanish.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC809 (FAS) - (06/04)
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