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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216369
Report Date: 08/14/2023
Date Signed: 08/14/2023 01:01:05 PM

Document Has Been Signed on 08/14/2023 01:01 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GARCIA FCC AKA COLORUM CHILDCAREFACILITY NUMBER:
426216369
ADMINISTRATOR:JESSICA MANUELA GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(747) 267-8964
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 17DATE:
08/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
06:40 AM
MET WITH:Jessica GarciaTIME COMPLETED:
01:15 PM
NARRATIVE
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On 8/14/23, Licensing Program Analyst (LPA) Elvin Baddley conduct an unannounced Plan of Correction inspection to address deficiencies cited during an Annual Random Inspection completed at the above referenced Family Child Care Home (FCCH) on 8/1/23. Namely, LPA is to check for corrections related to the staff to children ratio, children's records and the criminal clearance of individuals working at the FCCH.

LPA met with Licensee Jessica Garcia. LPA explained the nature and reason of the inspection. At 6:45 AM, LPA toured the FCCH and observed 17 children in care. LPA reminded the Licensee of the capacity (14) set forth in the facility license. LPA also inquired if the Licensee was solely providing supervision and care of the [17] children on site. Licensee replied in the affirmative and informed LPA an Assistant would be arriving shortly. Further, Licensee informed LPA some of the children would be transported to local elementary schools within the hour. LPA notes an Assistant, Damaris Alexia Esparanza Sosa, did arrive at the facility about 10 minutes after LPA's arrival to provide care and supervision.

LPA reviewed the children's files. At 10:00 AM, LPA observed children files (C7, C12) without immunization records. It should be noted the children lacking immunization record have been enrolled in the FCCH over 30 days. LPA reminded Licensee of the need to have the immunization records of children on site and in the respective children's file. Licensee informed LPA Licensee is waiting for caregivers to submit the immunization records for the children's files.

LPA also observed children's files (C1- C17) lacking the Acknowledgement for Licensing Report forms (LIC 9224) with regard to the Noncompliance Conference of 8/7/23. C1, C5 and C15 lacked LIC 9224 forms related to 8/1/23 Inspection whereby a Type A was cited. Licensee was reminded each parent/guardian of enrolled children and parents/guardian of newly enrolled children during the next 12 months shall sign the Acknowledgement of Receipt form and the form shall be maintained in each child's file.
(CONT. 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
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: GARCIA FCC AKA COLORUM CHILDCARE
FACILITY NUMBER: 426216369
VISIT DATE: 08/14/2023
NARRATIVE
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At 10:45 AM, LPA informed Licensee of need to submit a written plan of correction as specified in the Noncomplainace Conference held on 8/7/23. Licensee authored the written plan of correction and forwarded the plan, via email to Licensee's assigned LPA.

Today, Type A and Type B deficiencies are 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 have received a copy of the report LIC 809, LIC 809-C and LIC 809 D.

A notice of site visit was given and must remain posted for 30 days or a civil penalty of $100 may apply.

Exit interview conducted and report was reviewed with the Facility representative Jessica Garcia.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
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
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/14/2023 01:01 PM - It Cannot Be Edited


Created By: Elvin Baddley On 08/14/2023 at 11:28 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: GARCIA FCC AKA COLORUM CHILDCARE
FACILITY NUMBER: 426216369

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2023
Section Cited
CCR
102418(g)

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 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:Based on the review of
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Licensee will submit a copy of C7 and C12 immunization record to CCLD by 8/28/2023, to CCLD via email: Elvin.Baddley@dss.ca.gov
A immediate civil penalty of $250.00 is assessed
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children's files revealed C7 and C12 did not have immunization records on file, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/28/2023
Section Cited
HSC1596.8595(c)(1)

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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care. This was not met as the files
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Licensee to provided Inpsection Report of 8/1/23 and Noncomplaiance Conference of 8/7/23 to parents of children in care along with LIC 9224. Signed LIC 9224 form to be retained in file. Aforementioned to be completed by 8/28/23.
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C1-C17 did not have signed LIC 9224 with regard to noncomplaince conference. C1, C5 and C15 did not have LIC 9224 regarding 8/1/23 Annual/random Hearing 8/7/23 whereby a type A defic, was cite,, which poses 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:Elvin Baddley
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 01:01 PM - It Cannot Be Edited


Created By: Elvin Baddley On 08/14/2023 at 12:03 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: GARCIA FCC AKA COLORUM CHILDCARE
FACILITY NUMBER: 426216369

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
102416.5(d)(2)

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For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time when there is an assistant provider in the home... This was not met as LPA observed 17 children in care during inspection conducted on 8/14/23, which poses/posed an immediatehealth,
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Licensee to provide a written plan to CCLD with regard to effoerts to be taken to ensure the FCCH is not over capacity. Aforementioned to be submitted no later than 8/15/23 to Elvin.Baddley@dss.ca.gov.
A immediate civil penalty of $250.00 is assessed
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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:Elvin Baddley
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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