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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216404
Report Date: 08/06/2025
Date Signed: 08/06/2025 03:49:26 PM

Document Has Been Signed on 08/06/2025 03:49 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:CUNA FCC AKA DRAGONFLY PLAY HOUSEFACILITY NUMBER:
426216404
ADMINISTRATOR/
DIRECTOR:		JUANA M. CUNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 314-9533
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/06/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Juana CunaTIME VISIT/
INSPECTION COMPLETED:
04:03 PM
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On 08/06/2025 at 1:00 PM, Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Required 3 Year inspection of the abovementioned Large Family Child Care Home (FCCH). LPA met with licensee Juana Cuna and informed them of the purpose of the visit. LPA in the company of the licensee toured the interior and exterior of the facility and observed required documents posted in a prominent and publicly accessible area of the home. The hours of operation are from 12:00 AM to 11:59 PM, Monday through Saturday. During the inspection, LPA observed 11 children in care with the licensee and two adult assistants providing care and supervision.

The home is a single story 4 bedroom, 2 bathroom home. The FCCH operates out of the living room, 1 bedroom, 1 bathroom, kitchen, dining room, and an outdoor play area at the back. The rest of the home is excluded from child care. LPA observed the living room is used for childcare activities and 1 bedroom is used as an activity and nap room. LPA observed napping children during the inspection, where infants were in placed in cribs with blankets, which is not in compliance with Title 22 Regulations. LPA observed a screened fireplace in the living room. The rooms used for child care were observed to be clean, organized, and appropriately furnished. The child care bathroom was observed to be clean and free of hazardous items. LPA observed that sharps and cleaning supplies are stored in locked kitchen cabinets inaccessible to children in care. Medicines are stored in a locked closet. Off-limit bedrooms are made inaccessible by a children’s gate in the hallway. LPA observed one older day care child in an off-limit bedroom with one of the licensee’s children. LPA observed two dogs present in the off-limit garage made inaccessible by children’s gate. Licensee states vaccines for the animals are up to date. Licensee stated no firearms or ammunition are stored in the home. No bodies of water were observed.

Continued on 809-C.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2025
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: CUNA FCC AKA DRAGONFLY PLAY HOUSE
FACILITY NUMBER: 426216404
VISIT DATE: 08/06/2025
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LPA observed a dual carbon monoxide detector and smoke alarm in the hallway, which was tested at 3:00 PM and found to be operable. LPA observed a regulation fire extinguisher that was last serviced on 10/09/2024. Licensee stated disaster and fire drills are conducted monthly. Last fire drill was conducted and documented on 07/09/2025. The outdoor play area is enclosed by wooden fencing where parents have access to the day care via latched gate. LPA observed two locked storage sheds inaccessible to children. LPA also observed one unlocked storage shed free of hazards which licensee stated children have access. Outdoor toys and play equipment are age appropriate. Shade is provided by gazebo and multiple umbrellas.

A sample of children and staff records were reviewed. The children’s records were found to be incomplete, which were missing the 15 minute sleep charts for infants 24 months and younger, which is not in compliance with Title 22 Regulations. Staff records contained current Pediatric First Aid/CPR certifications and Mandated Reporter training. Licensees’ Pediatric First Aid/CPR expires on 07/12/2026 and Mandated Reporter expires on 07/09/2026. Licensee was reminded to keep training certifications current and updated prior to expirations. All adults present in the home were associated and cleared.

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.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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. LPAs 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.

Continued on 809-C.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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: CUNA FCC AKA DRAGONFLY PLAY HOUSE
FACILITY NUMBER: 426216404
VISIT DATE: 08/06/2025
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

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

During the exit interview, the licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today’s inspection, 2 Type-B Deficiencies were cited on the attached LIC809-D. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were provided, and report was reviewed with the licensee Juana Cuna.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/06/2025 03:49 PM - It Cannot Be Edited


Created By: Bill-Brian Billones On 08/06/2025 at 02:45 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: CUNA FCC AKA DRAGONFLY PLAY HOUSE
FACILITY NUMBER: 426216404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
LPA observed two napping infants in cribs covered with blankets. LPA confirmed the children as infants 24 months and younger according to the facility's children's roster.
POC Due Date: 08/06/2025
Plan of Correction
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Licensee removed the blankets from the sleeping infants during the inspection. Licensee will review Title 22 Infant Safe Sleep Regulations to ensure compliance. LPA printed a copy of the infant sleep regulations for licensee.
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
LPA did not observe infant sleep charts in the infant files. Licensee stated they believed the sleep chart wrre required for children up to 12 months.
POC Due Date: 08/20/2025
Plan of Correction
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LPA informed licensee to maintain sleep charts for children (infants) 24 months and younger. Licensee will create sleep charts for infants and submit proof of the documented correction to Licensing Program Analyst Bill Billones via email at bill.billones@dss.ca.gov no later than 8/20/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Bill-Brian Billones
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
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