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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217092
Report Date: 06/25/2025
Date Signed: 06/25/2025 11:37:32 AM

Document Has Been Signed on 06/25/2025 11:37 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:AREVALO FAMILY CHILD CAREFACILITY NUMBER:
426217092
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
06/25/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Meleena ArevaloTIME VISIT/
INSPECTION COMPLETED:
11:42 AM
NARRATIVE
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On 06/25/2025 Licensing Program Analyst (LPA) Bill Billones conducted an unannounced Case Management - Change of Capacity inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with Licensee Meleena Arevalo and informed them the purpose of the inspection. At the time of the inspection, the Licensee and 2 assistants providing care and supervision to 7 children present in the home.

LPA in the company of the Licensee toured the FCCH. LPA notes that during the inspection there was ongoing construction in the backyard of the FCCH. Licensee stated they called the Regional Office to inform the Department of the construction. LPA requested an updated construction plan detailing the work being done and a timeline of work when completed.

During the inspection, LPA observed a bottle of cleaning solution on the kitchen counter in proximity to prepared food and personal care products on a shelf in the living room accessible to children in care. LPA reminded Licensee that all cleaning compounds and chemicals should be out of reach of children.

LPA observed a fire extinguisher (3A40BC) that did not have a service ticket or proof of purchase receipt. LPA reminded Licensee the responsibility to service or purchase a regulation fire extinguisher annually. LPA reviewed Licensee’s Mandated Reporter Training certificate which was completed 05/05/2025. LPA notes one assistant who provides care to children did not have Mandated Reporter Training. LPA reviewed Licensee’s Pediatric CPR/First Aid which was completed 03/06/2025. LPA observed the home to have a combination smoke and carbon monoxide detector in the home, which was tested at 9:12 AM and found to be operable. LPA reviewed the Children’s Roster and observed one child (C1) that was present, but not listed. LPA notes FCCH did not have a file or sleep logs for C1.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2025
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
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: AREVALO FAMILY CHILD CARE
FACILITY NUMBER: 426217092
VISIT DATE: 06/25/2025
NARRATIVE
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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 a fire clearance following an inspection completed at FCCH on 05/22/2025.

The Change of Capacity (Large FCCH License) is pending Licensing Program Manager approval.

During today’s inspection, three Type B deficiencies were cited and can be found the attached 809-Ds. Two technical violation was also issued.

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

Exit interview conducted, appeal rights were provided, and report was reviewed with the Licensee, Meleena Arevalo.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Bill-Brian Billones
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/25/2025 11:37 AM - It Cannot Be Edited


Created By: Bill-Brian Billones On 06/25/2025 at 10:26 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: AREVALO FAMILY CHILD CARE
FACILITY NUMBER: 426217092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2025
Section Cited
CCR
102417(g)(1)

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102417 Operation of a Family Child Care Home (g) ...Safety precautions shall include... (1) ...The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal. This requirement was not met as evidenced by:
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Licensee will purchase or servisce existing fire extinguisher and submit proof of correction to LPA Billones via email no later than 07/09/2025.
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Based on observations, Licensee did not comply with the section cited above, which poses a potential health, safety, and personal rights risk to children in care.
LPA observed a regulation fire extinguisher without a proof of purchase receipt or an annual service ticket.
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Type B
06/26/2025
Section Cited
CCR102417(g)(4)

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102417 Operation of a Family Child Care Home (g) ...Safety precautions shall include... (4) Poisons, detergents, cleaning compounds.... 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 removed the cleaning compound and the personal care products to an area innaccessible to children in care during visit on 06/25/2025.
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Based on observations, Licensee did not comply with the section cited above, which poses a potential health, safety, and personal rights risk to children in care.
LPA observed a cleaning compound on the kitchen counter and multiple personal care products accessible to children 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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Bill-Brian Billones
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2025


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/25/2025 11:37 AM - It Cannot Be Edited


Created By: Bill-Brian Billones On 06/25/2025 at 10:45 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: AREVALO FAMILY CHILD CARE
FACILITY NUMBER: 426217092

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/09/2025
Section Cited
HSC
1596.8662(b)(1)

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1596.8662(b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training... This requirement was not met as evidenced by:
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Licensee will ensure all employees, including assistants will complete Mandated Reporter Training. Licensee will submit proof of training certificate to LPA Billones via email no later than 07/09/2025.
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Based on observation, interview, and record review, the Licensee did not comply with the section cited above, which poses a potential health, safety, and personla rights risk to children in care. LPA reviewed one assistant caring for children did not have Mandated Reporter training.
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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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Bill-Brian Billones
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2025


LIC809 (FAS) - (06/04)
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