426216874-2-2-2026-17-CC-JMEZ-DQX2J4-20260202162542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216874
Report Date: 02/02/2026
Date Signed: 02/02/2026 04:26:05 PM

Document Has Been Signed on 02/02/2026 04:26 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:	MENA FAMILY CHILD CARE		FACILITY NUMBER:	426216874
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 6	DATE:	02/02/2026
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Rosalba Mena		TIME VISIT/ INSPECTION COMPLETED:	04:40 PM

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On February 2, 2026 @ 1:00 PM, Licensing Program Analysts (LPAs) Joaquin Mendez and Izak Diaz conducted an unannounced Annual Inspection and capacity increase visit of the abovementioned Family Childcare Home (FCCH). LPAs met Rosalba Mena, licensee. The Licensee is requesting a capacity increase from 8 children (small license) to 14 children (large license). LPA observed appropriate licensing forms and documents posted prominently to a bulletin board at the entry of the FCCH. At the time of inspection there is the licensee, with six (6) children in care. LPAs note all adults are cleared through Guardian website. Per Applicant, the operating hours will be Monday through Saturday from 5:00 a.m. to 5:00 p.m. Applicant states she wants to care for children from 0 to 6 years of age.

The residence has five (5) bedrooms, three (3) bathrooms, a living room, kitchen, dining room, and back yard. The areas to be used for childcare within the residence are the living room, dining room, one (1) bedroom (furnished for daycare), Office (napping room), downstairs restroom, and backyard. While the remainder of the home is excluded from care. LPAs observed locks and doorknob covers on all remaining bedroom doors, making these rooms inaccessible to children in care. LPAs observed a gate preventing access to the kitchen. LPAs observed the residence to be clean and orderly. Additionally, the residence has spaced and ventilation for children in care.

All areas identified on the facility sketch were inspected. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the FCCH to be orderly and clean. However at 1:49PM the LPAs found toothpaste and Fabreeze air freshener within Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

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 02/02/2026 04:26 PM - It Cannot Be Edited

Created By: Joaquin Mendez On 02/02/2026 at 02:42 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: MENA FAMILY CHILD CARE	FACILITY NUMBER: 426216874
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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 is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in toothpaste and fabreeze were found accessible to children in care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/03/2026
	Plan of Correction
1 2 3 4	Licensee immediately removed the items. The licensee will send her POC stating how she will remenber to secure toxic and hazardous items outside of children's reach. POC will be sent to LPA by the end of bussiness day 2/3/2026. Bussiness card left with contact information.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

	Joaquin Mendez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

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: MENA FAMILY CHILD CARE	FACILITY NUMBER: 426216874
	VISIT DATE: 02/02/2026

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the reach of children.

LPAs with the licensee toured the backyard fenced by wood with footing consistent with grass, loose dirt and gravel. The LPAs reminded the licensee that constant supervision must be maintained when children are outside. LPAs observed a shed in the area children have access to that is locked and inaccessible. The licensee states children must pass through an area of the back yard where tools and recycles are stored. LPAs advised the licensee that this area must be secured prior to usage of this area for children to pass through. The licensee states she will build a fence to keep children away from the tools and bags of recycling area. The licensee states the fence will be built by the end of business day on 2/12/2026. LPAs note at 2:00PM a baby walker is observed in the backyard where children have access. The licensee states no one plays with the baby walker and the baby walker was a gift from one of the parents. LPAs remind the licensee the importance of keeping items that a prohibited away from children’s reach.

The children’s records were reviewed. The records are current and complete with emergency contact information, immunization records, and other required licensing forms and documents. However, when asked for the infant sleep charts. The licensee was able to explain that she checks every fifteen minutes and states what to look for. However, there is no documentation. The licensee states she does not know the form and does not know how to fill it out. LPAs will instruct the licensee on how to complete the form. The Licensee’s records were reviewed and found to be current with CPR/First Aid certifications (expires 3/27/2027) and Mandated Reporter training (expires 2/28/2027). LPAs note the most recent fire/emergency drill was conducted on 12/18/2025 with 3 children present. Licensee states there are no firearms or ammunition stored on site.

The Licensee does not currently provide medication or Incidental Medical Services (IMS) to current children in care. IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

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: MENA FAMILY CHILD CARE	FACILITY NUMBER: 426216874
	VISIT DATE: 02/02/2026

NARRATIVE

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webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

No prohibited equipment will be allowed or used in the home. No baby bouncers, No infant walkers, No Johnny jumpers, No saucer chairs, No trampolines and any other item that falls into that category are not permitted in the facility.

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.

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.

The licensee, Rosalba Mena provided proof of control of property.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility. LPAs completed an RSO profile in FAS.

On December 02, 2025, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted fire clearance following an inspection completed at FCCH on January 30, 2026. Fire Clearance is granted with the special conditions noted below.

Daycare provider has changed the evacuation plan to ensure a proper egress route. The new evacuation plan has been uploaded to the occupant’s documents. The inspection has been approved with the condition of community care licensing approval of the updated evacuation plan.

Based on inspection of the facility, the facility is cited a Type A deficiency, a LIC9102TV, and LIC9102TA. Deficiencies listed on the attached LIC 809D (deficiency page) in accordance with Title 22 Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

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: MENA FAMILY CHILD CARE	FACILITY NUMBER: 426216874
	VISIT DATE: 02/02/2026

NARRATIVE

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Regulation code. Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to the licensee.

The application is pending subject for completion of the following:

- Backyard must have hazardous items removed or a fence built to secure area from children's reach.

Applicant will send photos to confirm all corrections have been completed to LPA Mendez. LPA Mendez left business card with information for the applicant. Corrections will be sent to LPAs by the end of business day February 12, 2026.

A notice of site visit was given and must remain posted for 30 days during facility’s hours of operation. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
An exit interview was conducted, and a copy of the report was provided, along with appeal rights to licensee Rosalba Mena in her preferred language, Spanish.

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

LIC809 (FAS) - (06/04)

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