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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216941
Report Date: 03/21/2025
Date Signed: 03/28/2025 04:12:59 PM

Document Has Been Signed on 03/28/2025 04:12 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:PACHECO HERNANDEZ FAMILY CHILD CAREFACILITY NUMBER:
426216941
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
03/21/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Irma Pacheco HernandezTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 3/21/2025, at 9:15 AM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an announced Pre-licensing Inspection and met with Applicant, Irma Pacheco Hernandez and spouse (Rene Miguel Garcia). LPA informed Applicant of the nature and purpose of the inspection. The applicant informed the LPA of the intention to maintain operating hours of a Family Childcare Home (FCCH) from 4:00 AM to 7:00 PM, Monday- Sunday. The applicant also informed LPA of the intention to provide care for children 0 to 13 years of age. Applicant was informed changes in licensing hours and/or the ages of children supervised and cared for can be altered upon notifying CCLD in writing of the given modifications and/or changes. The applicant reports there are four (4) adults that live in the home and four (4) adults has received criminal record clearance. LPA notes that at the time of inspection there was the applicant and spouse in the home.

LPA toured the interior and exterior of the residence with the Applicant. This is a single-story home. The home consists of three (3) bedrooms, two (2) bathrooms, living room area, playroom (furnished and decorated for daycare), kitchen, dining room, garage, and back outdoor covered patio. Applicant reported day care services will occur in playroom, one (1) hallway bathroom, living room, dining room, kitchen, and covered backyard patio area. Meanwhile, the three (3) bedrooms, second bathroom, and garage are inaccessible. Additionally, LPA observed a doorknob covers on the bedrooms and a gate in the hallway making them inaccessible to children in care.

LPA observed that the areas designated for daycare use to have plenty of spacing and ventilation for the comfort of children in care. The bathroom was clean and orderly. LPA notes there are no toxins and dangerous items in the bathroom accessible to children in care.
· The living room has a fireplace with a lock on the screen door and a gate making it inaccessible to children in care.
· The home has a carbon monoxide and was tested and functioning at 9:43 AM. A smoke detector was Continue on LIC809C pg2
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2025
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
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: PACHECO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216941
VISIT DATE: 03/21/2025
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tested at 9:44 AM and functioning.

· LPA observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. LPA observed two (2) baby walkers which the applicant removed to the garage. The applicant stated she was unaware she could not have them. The licensee stated she would gift them away to someone and would not be part of daycare use.

· LPA notes, the applicant does have multiple sleep cots and a playpen to meet the children’s sleeping needs.

· LPA reminded the Applicant of the importance of monitoring infants and keeping up with the infant safe sleep plan and log.

· Family medication is in a dresser in the applicant’s bedroom and inaccessible to children in care. There is other medication in Bedroom three (3) and inaccessible.


· LPA observed a gate in the hallway preventing access to the washroom area in the hallway making this area inaccessible. Above the washing machine and dryer are elevated cabinets where detergents and bleach stored, inaccessible to children.
· Knives are stored in a locked elevated cabinet in the kitchen.
· Dish soap and cleaning supplies are in the locked elevated cabinet in the kitchen.
· LPA observed a required fire extinguisher (2A10BC) in the home in the living room with a service date of 4/30/2024. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually.
· Kitchen stove has covers over the knobs preventing any accidental turning of the knobs.
· Applicant reported drinking water will be accessible by means of the homes filtration system. Water bottles and a water dispensing unit are also provided when needed. Applicant stated they will use individual water cups for the children in care.

LPA observed the back patio area to be fenced by a wood and concrete with a side gate providing entrance and exit. The exit will only be used as an emergency exit should an emergency arise. The surface area is concrete and artificial turf for the comfort of children.
· The licensee states an area with no access is gated off with trash bins and family pets (Two 2 small dogs). LPA did not observe any items which could pose harm to children in care. LPA reminded the applicant to Continue on LIC809C pg3
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
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: PACHECO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216941
VISIT DATE: 03/21/2025
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always supervise the children in care.
· LPA observed items, equipment, toys, and furnishings for the children in care that are in good condition and age appropriate. LPA advised the Applicant to check daily for insects and animals which may pose a threat to children in care prior to children having access to play structures and toys.
· LPA notes no bodies of water were observed.

Applicant reported there are no guns and ammo in the home where the FCCH will operate.

LPA record review revealed all documents as noted below.
· Applicant completed FCCH orientation on 2/06/2024.
· LPA observed the completed Statement acknowledging requirements to report suspected child abuse (LIC 9108)
· Preventative Health training was complete on 3/07/2024.
· Pediatric CPR/First Aid (EMSA approved) and expires 2/2026.
· Applicant completed Mandated Reporter training with an expiration date 10/24/2026.
· LPA observed immunization records for the licensee. LPA reminded Applicant of obligation to maintain current training and certifications.
· Applicant does not have liability insurance for the license yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

Applicant 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.

Because the applicant Irma Pacheco Hernandez rents the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Continue on LIC809C pg4

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: PACHECO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216941
VISIT DATE: 03/21/2025
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APPLICANT Irma Pacheco Hernandez stated she will not provide Incidental Medical Services (IMS). 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/. http://www.ada.gov/childqanda.htm

LPA reviewed with applicant Irma Pacheco Hernandez, the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist (LIC126) was provided to the applicant.

LPA discussed the safe sleep regulations with applicant, 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. LPA also informed applicant 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.



On this date, 3/21/2025, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https:// www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
Continue on LIC809C pg5
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PACHECO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216941
VISIT DATE: 03/21/2025
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Applicant, informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license is today, March 21, 2025.

A notice of site visit was given to applicant Irma Pacheco Hernandez, and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the applicant, Irma Pacheco Hernandez in the preferred language, Spanish.
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025
LIC809 (FAS) - (06/04)
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