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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 426216426
Report Date: 08/20/2024
Date Signed: 08/21/2024 03:55:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2024 and conducted by Evaluator Martina Jimenez
COMPLAINT CONTROL NUMBER: 17-CC-20240814103734
FACILITY NAME:SILVA MEDINA FAMILY CHILD CAREFACILITY NUMBER:
426216426
ADMINISTRATOR:ELIZABETH SILVA MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 201-8992
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 10DATE:
08/20/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elizabeth Silva MedinaTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Licensee has unpermitted construction being conducted
INVESTIGATION FINDINGS:
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On 8/20/2024, at 1:30 PM, Licensing Program Analyst (LPA) Martina Jimenez, conducted an unannounced inspection of the Family Child Care Home (FCCH) to initiate a compliant investigation reference to the above allegation.

LPA met with Elizabeth Silva Medina, licensee, Laura Barajas, assistant and Cinthia Pineda Luna, assistant. LPA Jimenez explained the nature and purpose of the investigation. LPA observed two (2) infants, and eight (8) children napping at the time of the inspection.

The investigation included one (1) unannounced inspections, LPAs observation, interview with licensee, and assistant, review of children's files, and, documents obtained during the inspection.

CONT LIC 9099-C, LIC 9099D
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20240814103734
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: SILVA MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426216426
VISIT DATE: 08/20/2024
NARRATIVE
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The allegation references the licensee has un-permitted construction being conducted. The licensee stated that approximately mid October of 2023, construction on the first ADU was started and completed in two weekends, which is located behind the garage. The first ADU was occupied on February 1, 2024.

The second ADU of the conversion of the garage started approximately November 1, 2023 and was completed in December 2023. The licensee stated the second ADU was rented to an adult who did not have a criminal record clearance on February 2024, lived in the ADU for approximately one week and moved. The licensee stated does not know the adult women's name or current address. The second tenant moved in on June 1, 2024. The two adults that currently resided in the two (2) ADU's have criminal record clearance.

The licensee stated the construction was done only on weekends (Saturday & Sunday) from 9:00am - 5:00pm, When the FCCH is closed. The licensee did not obtain building permits for the two ADUs, and did not notify CCLD of the construction.

Today’s visit was conducted in Spanish by LPA Jimenez. Based on LPA’s observation, interview with licensee, record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, (Title 22 Division 12 and 102416.3(a), is being cited on the attached LIC 9099 D).


Today, deficiency cited under Title 22 Division 12, Appeal rights provided to licensee. LPA provided the Licensee a Notice of Site (LIC 9213) visit which was posted in the LPA's presence. this REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20240814103734
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: SILVA MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426216426
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2024
Section Cited
CCR
102416.3(a)
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(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified
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Licensee will submit a written statement on how licensee will prevent future incidents to CCLD, and update facility sketch (LIC 999A)by 8/27/2024, via email to: Martina.Jimenez@dss.ca.gov
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 as "off limits" to an area where care and supervision will be provided to children in care. This requirement is not met as evidenced by: LPA observed the garage was converted into an ADU and a second ADU behind the garage, which the licensee stated are un-permitted. 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.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
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