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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216941
Report Date: 04/30/2026
Date Signed: 04/30/2026 10:29:47 AM

Document Has Been Signed on 04/30/2026 10:29 AM - 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: 7DATE:
04/30/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Irma PachecoTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On April 30, 2026, at 8:25 AM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an unannounced Annual Random inspection and capacity increase visit of the abovementioned Family Childcare Home (FCCH). LPA met with Irma Pacheco Hernandez, Licensee of the FCCH and explained the nature and purpose of the inspection. 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 were the licensee and (7) children in care.

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 covered patio for daycare), kitchen, dining room, garage, and backyard. Day care services are provided in playroom, one (1) hallway bathroom, living room, dining room, kitchen, and backyard. 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 a fire extinguisher that satisfies regulation (2A10BC). Purchase date 4/11/2026. LPA reminded applicant that it IS HER responsibility to purchase or service a regulation fire extinguisher annually. LPA observed and tested the smoke and carbon monoxide detectors at 8:59 AM were found to be functioning.

LPA observed the kitchen to have safety locks on drawers and cabinets making these areas inaccessible to children in care. LPA observed the FCCH to be orderly and clean. LPA observed that knives, sharps, chemicals and cleaning supplies are stored in locked elevated cabinets in the kitchen and medication is

Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2026
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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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: 04/30/2026
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stored in the licensee’s bedroom, inaccessible at the time of the inspection. The bathroom to be used for children in care was observed to be clean and free of toxins. LPA observed child size furniture and material for activities throughout the home in areas that will be accessible to children in care.

LPA observed the backyard area to be fully fenced by wood. The playground is made up of varying surfaces (concrete pavement and artificial turf for cushioning). Licensee informed LPA that children are always supervised when engaged in outdoor activities. LPA together with the Licensee toured the outdoor play area. LPA observed a fenced off area for storage in the backyard and is locked and inaccessible to children. LPA also observed and confirmed that there are no bodies of water on site.

LPA reviewed children's records. The records are current and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. The Licensee's records were also viewed. The Licensee’s Pediatric CPR and First Aid certifications (EMSA approved) expiring on 1/22/28. Mandated Reporter Training, expiring on 10/24/26, is current and complete as are other relevant licensing forms and documents. Licensee was reminded to renew certifications and training prior to expirations. The Licensee verbally stated that there are no firearms or ammunition stored on site.

Because the licensee 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).

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 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 Continue on LIC809C

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

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
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: PACHECO HERNANDEZ FAMILY CHILD CARE
FACILITY NUMBER: 426216941
VISIT DATE: 04/30/2026
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not permitted in the facility.

LPA 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.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility when the LPA completed a RSO profile in FAS on April 30, 2026.

On 4/01/2024, 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 4/08/2026.

No deficiencies were cited during today’s inspection. Licensee was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

The home meets Title 22 of CCR provisional requirements for a Large Family Childcare license effective today. Effective date of license is today April 30, 2026.

A notice of site visit was given to applicant 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 licensee, Irma Pacheco Hernandez in Spanish.

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

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC809 (FAS) - (06/04)
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