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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216596
Report Date: 11/06/2024
Date Signed: 11/06/2024 01:57:30 PM

Document Has Been Signed on 11/06/2024 01:57 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 FCCHFACILITY NUMBER:
426216596
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
11/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Guadalupe GarciaTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
NARRATIVE
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On 11/06/2024, at 7:30 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced inspection of the Family Child Care Home (FCCH) to initiate a investigation. LPA met with Guadalupe Gacia, licensee and Miguel Pena-Escobar, assistant/husband. LPA explained the purpose of the inspection. LPA observed three six (6) children in the home at the time of the inspection.

LPA informed the licensee that LPA has been knocking and rang the doorbell several times, with no response. Once inside the home LPA observed the gate to the stairs was open, the assistant in the home with seven (7) children and four (4) of the children were licensee's own children, which one of the children is over the age of ten years old.

At 7:49 AM, LPA observed C1 open the safety gate to the stairs, go upstairs and return back downstairs at 7:51 AM. At 7:53 AM, C1 once again open the safety gate went back upstairs and returned downstairs at 7:55 AM.

LPA with the licensee toured the interior and exterior of the home, including the second story of the home. LPA observed in bedroom #1, #2, & #3 the following items; Body

Continues on LIC9099C & LIC 9099D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 FCCH
FACILITY NUMBER: 426216596
VISIT DATE: 11/06/2024
NARRATIVE
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power, personal hygiene products (cleaner, toner, lotions, perfumes, pain mediations, deodorants, ect..) and bedroom #4 was secured at the time of the inspection.

Today’s visit was conducted in Spanish by LPA Jimenez. This report was translated in Spanish by LPA Jimenez. Today, deficiency cited under Title 22 Division 12, Spanish Appeal rights provided to licensee.

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 LIC 9099 and LIC 9099 D.

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.



LPA left the FCCH from 11:56 AM, and returned at 12:56 PM.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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Document Has Been Signed on 11/06/2024 01:57 PM - It Cannot Be Edited


Created By: Martina Jimenez On 11/06/2024 at 11:46 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 FCCH
FACILITY NUMBER: 426216596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2024
Section Cited
CCR
102417(g)(3)

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Where children less than five years old are in care, stairs shall be fenced or barricaded. This requirement was not met as evidenced by LPA observed the safety gate
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Licensee shall submit a written statement to CCLD on how licensee will prevent future incident from occurring by 11/7/2024.
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to the stairs was open, the assistant in the home with seven (7) children At 7:49 AM, LPA observed C1 open the safety gate to the stairs, go upstairs and return back downstairs at 7:51 AM. At 7:53 AM, C1 once again open the safety gate went back upstairs and returned downstairs at 7:55 AM, which poses an immediate Health, Safety or Personal Rights risk to persons in care.
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Type A
11/07/2024
Section Cited
CCR102417(g)(4)

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The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children, This requirement was not met as evidenced by
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Licensee shall submit a written statement to CCLD on how licensee will prevent future incident from occurring by 11/6/2024.
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evidenced by LPA observed in bedroom #1, #2, & #3 the following items; Body power, personal hygiene products (cleaner, toner, lotions, perfumes, pain mediations, deodorants, ect..) which poses an immediate 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:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


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