426216793-10-22-2025-17-CC-SPAR-DMQ2D6-20251022171750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216793
Report Date: 10/22/2025
Date Signed: 10/22/2025 05:17:59 PM

Document Has Been Signed on 10/22/2025 05:17 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:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	426216793
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 5	DATE:	10/22/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:38 PM
MET WITH:	Maria Chavez Barajas		TIME VISIT/ INSPECTION COMPLETED:	05:35 PM

NARRATIVE

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NOTE: Today’s inspection was translated between English and Spanish using telephonic interpreting services, ID# 98478590.

On 10/22/2025, at 2:38 PM PST, Licensing Program Analyst (LPA) Seena Parsapour conducted an unannounced Annual/Random inspection of the above-mentioned Family Child Care Home (FCCH). LPA met with licensee Maria Chavez Barajas. LPA explained to licensee the purpose of the inspection and, in the company of the Licensee, toured the interior and exterior of the FCCH. For daycare purposes, the FCCH uses the living room, kitchen & dining areas, one (1) bathroom, and outdoor area. The remainder of the FCCH is off-limits, with off-limits areas enforced by various means including door handle locks & latches. LPA notes that the home is a single story, two (2) bedroom, one (1) bathroom home. At the time of the inspection, LPA observed five (5) children in care, and there were no assistants present.

LPA observed family medications, cleaning supplies, knives, and other hazardous items stored in areas inaccessible to children. The bathroom for the FCCH was observed to be clean and hazard-free. Toys, furniture and equipment observed in the FCCH were found to be age appropriate. LPA observed required licensing forms and documents posted on a bulletin board near the entrance of the FCCH. Separate smoke & carbon monoxide detectors were present in the FCCH; one of each type was tested at 4:09PM PST & found to be operational. The FCCH has a regulation fire extinguisher (2A10BC) that was recently serviced on 4/07/2025. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The outdoor area is accessible for daycare purposes, is not enclosed, and the footing consists of concrete and grass. LPA reminded licensee that care and supervision are required at all times when children are inside or outside of the FCCH. LPA reminded Licensee to replace toys and play equipment when such items begin to degrade or are not in good repair. LPA observed no bodies of water on site, and confirmed this was the case with Licensee. (Cont. 809-C, Page 2)

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

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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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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Document Has Been Signed on 10/22/2025 05:17 PM - It Cannot Be Edited

Created By: Seena Parsapour On 10/22/2025 at 04:41 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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216793
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). (1) The licensee shall keep the signed and dated notice form for at least three years following termination of service to the child. (b) The licensee shall maintain, in each child's record, a copy of the emergency information card as required in Section 102417(g)(7). (c) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, a copy of documentation verifying the child's enrollment and attendance at kindergarten, including transitional kindergarten, or elementary school as required in Section 102416.5(g). (d) In any case in which the licensee cares for an additional child pursuant to Section 102416.5(b) for a Small Family Child Care Home or Section 102416.5(d) for a Large Family Child Care Home, the licensee shall maintain, in the child's record, proof of parent notification that the facility is caring for an additional child as required in Section 102416.5(h). (1) The licensee shall maintain a completed and signed LIC 9150 (Rev. 8/14) Parental Notification Additional Children in Care, which is incorporated by reference, for this purpose. (e) In any case in which a licensee releases a minor to a peace officer pursuant to Section 305 of the Welfare and Institutions Code, the licensee shall provide the peace officer with the address and telephone number of the minor's parent or authorized representative in order to enable the peace officer to make the notification required by Section 308 of the Welfare and Institutions Code. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in that Child #05 (C5) did not have any enrollment documentation on file as required, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/31/2025
	Plan of Correction
1 2 3 4	Licensee shall submit to the Department (seena.parsapour@dss.ca.gov) a written statement explaining how she plans on ensuring compliance with this regulation in the future, as well as proof of the above listed enrollment documentation being on file for Child #05 (C5), no later than October 31st, 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.

	Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:

	Seena Parsapour
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 426216793
	VISIT DATE: 10/22/2025

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Children’s records for all five children present at the time of the inspection were reviewed. At 3:48PM PST, during record review & upon interviewing the Licensee, LPA discovered that Child #05 (C5) did not have any enrollment documentation on file, as required. Licensee was reminded of their responsibility to ensure that current & complete records are maintained for each child in care. The children’s records were otherwise found to be current & complete. The Licensee’s records were reviewed, and were found to be current and complete. LPA notes the most recent disaster drill was conducted on 4/15/2025. LPA reminded licensee of the requirement to conduct & document such drills every 6 months. Licensee states there are no firearms or ammunition stored on site.

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 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.

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. 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.

During today's visit, one (1) Type B citation was issued under Title 22 of the California Code of Regulations and Health and Safety Codes (see LIC 809-D).

Appeal Rights were provided to Licensee. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Maria Chavez Barajas.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Seena Parsapour
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/22/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2025

LIC809 (FAS) - (06/04)

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