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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217135
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:37:58 PM

Document Has Been Signed on 03/11/2025 12:37 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 CAREFACILITY NUMBER:
426217135
ADMINISTRATOR/
DIRECTOR:
FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
03/11/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Yesenia ChavezTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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This a change of capacity. Original facility number is 426216305

On 3/11/25, at 10:45 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 Yesenia Chavez, 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, assistant (spouse), with 6 children in care. Licensee reports two (2) adults live in the home. LPA confirmed through Guardian website that two (2) adults have been criminal record cleared.

The LPA, in the company of Licensee, toured the interior and exterior of the FCCH. The FCCH is a three bedroom and two-bathroom single story home. The living room (converted play area), one bedroom, dining room, kitchen, bathroom located past the kitchen, and part of the home’s backyard are utilized for childcare services, while the remainder is excluded (two bedrooms and additional bathroom). LPA observed doorknob covers on the remaining bedrooms making them inaccessible.

LPA observed the FCCH to be orderly and clean.

· The bathroom, utilized for childcare services, is clean and free of toxins.

· Cleaning compounds were observed in an elevated cabinet in the washroom just passed the kitchen inaccessible to children in care.

· Sharps were observed in an elevated cabinet in kitchen.

· Medication was observed in an elevated cabinet in the washroom.

Continue on LIC809C pg2

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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 4
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: 426217135
VISIT DATE: 03/11/2025
NARRATIVE
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· LPA observed toys, books, furnishings, and other age-appropriate equipment throughout the interior (living room area) of the FCCH.

· LPA observed various combination smoke/carbon monoxide detectors throughout the home. A combination carbon monoxide/smoke detector was tested at 11:46AM and were found to be operational.

· LPA observed a regulation fire extinguisher in the FCCH, which was last purchased on 1/16/25. LPA reminded the Licensee to service or purchase a regulation fire extinguisher yearly.

· When reviewing records LPA notes fire/disaster drill logged 2/21/2025 at 10:30 AM. LPA reminded the licensee that the disaster drills must be conducted every 6 months per regulation.

LPA observed the backyard area to be fully fenced by wood. The playground is made up of varying surfaces (concrete pavement and grass areas for cushioning around the play area). Part of the area for daycare use is fenced off, preventing access to the rest of the back yard. Licensee informed LPA that children are always supervised when engaged in outdoor activities.

· LPA observed a shed in the backyard that is inaccessible by means of a fence with a gate. Inside the shed was the storage of yard tools.

· Like the interior of the FCCH, the backyard has age-appropriate equipment throughout the area that can appropriately afford for childcare services.

· LPA also observed and confirmed that there are no bodies of water on site.

LPA reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. The Licensee's records were also viewed and found to be complete.

· The Licensee’s Pediatric CPR and First Aid certifications (EMSA approved) expiring on 2/28/2026.

· Mandated Reporter Training, expiring on 8/22/26, 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.

Continue on LIC809C pg3

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: 426217135
VISIT DATE: 03/11/2025
NARRATIVE
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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 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 3/10/25.

On 1/09/2025, 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 a fire clearance following an inspection completed at FCCH on 1/21/2025.

Continue on LIC809C pg4

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: 426217135
VISIT DATE: 03/11/2025
NARRATIVE
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Today, no deficiencies were cited under Title 22 Division 12 Appeal rights given.

The home meets Title 22 of CCR provisional requirements for a Large Family Childcare license effective today. Effective date of license is today 3/11/2025.

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, Yesenia Chavez in the licensee’s preferred language, Spanish.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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