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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217271
Report Date: 04/11/2025
Date Signed: 04/11/2025 04:39:14 PM

Document Has Been Signed on 04/11/2025 04:39 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:CORREA FAMILY CHILD CAREFACILITY NUMBER:
426217271
ADMINISTRATOR/
DIRECTOR:		ESPERANZA CORREA TELLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-1854
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 41CENSUS: 4DATE:
04/11/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:51 PM
MET WITH:Esperanza Correa TIME VISIT/
INSPECTION COMPLETED:
04:52 PM
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On April 11, 2025, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Case Management inspection at the above-mentioned Family Child Care Home. LPA met with licensee Ezperanza Correa and informed them the purpose of the inspection. LPA notes the Stipulation Waiver, and Order CDSS No. 6423215103 states 1) Revocation: Stayed with Probation: Respondent's license is revoked upon the Department's adoption of the Stipulation as its Order. The revocation of the license shall be STAYED, for three (3) years during which the Respondent shall be granted probationary license subject to the limitations and conditions of the Stipulation and Waiver Order dated August 2, 2024. At the time of arrival LPA observed licensee drive 1 infant to their home. Upon entering the home 3 additional children (total 4) were in care and 2 assistants were present. LPA notes licensee's mother was present as well.

LPA reviewed posted documents/forms and notes required documents/forms are posted on the wall in the day care room. LPA observed the Decision and Order CDSS No. 6423215103 , which is located above the children's cubbies, which is visible to parents who enter the day care room. LPA reminded licensee parents must be allowed in the day-care children areas at their request.



LPA observed the FCCH to be clean and orderly. LPA observed 3 children were napping with sufficient napping equipment. LPA observed all adults present have a Criminal Record Clearance. During the inspection the 3 children present were picked up and an additional 5 children later arrived. LPA observed Child 5 was not on the Children's Roster (LIC 9040). 1 Technical Violation was issued as a result.


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NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2025
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426217271
VISIT DATE: 04/11/2025
NARRATIVE
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 LPA observed the files of the first 4 children to be current and complete. LPA notes all files reviewed had a signed Acknowledgment of Receipt of Licensing Reports (LIC 9224). LPA observed the 1 infant to have a current Individual Safe Plan and a current 15 - minute check log. (last entry 4/11/25).LPA observed staff files to be current and complete as well. LPA observed both staff and licensee have current Pediatric CPR/First Aid. LPA observed both assistants and licensee to have current Mandated Reporter Training as well.

During today's inspection LPA reviewed Stipulation Waiver, and Order CDSS No. 6423215103 with licensee. The following was reviewed:

1. Licensee (Respondent) shall operate the facility in strict compliance with the regulations and statutes governing the operation of a FCCH.

2. During the period of probation, the Department in its sole discretion may conduct unannounced site visits for the purpose of determining whether there is full compliance with the regulations and statutes governing the operation of a FCCH.

3. Licensee (Respondent) shall ensure that all individuals working, residing or volunteering in the facility shall obtain criminal record clearances or exemptions prior to their initial presence in the facility and shall maintain proof of such criminal record clearances or exemptions at the facility.

4. Licensee (Respondent) shall maintain current personnel records of each employee at the facility and ensure that all employees have a current certificate of CPR and first aid training on file at the facility.

5. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period.

6. Licensee (Respondent) is required to maintain an accurate, complete and current client roster which must be made available to the Department upon request. In addition, every child on the roster must have an accurate and complete file present at the facility. Respondent shall not care for children who are not on the facility's roster.

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NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: CORREA FAMILY CHILD CARE
FACILITY NUMBER: 426217271
VISIT DATE: 04/11/2025
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7. Licensee (Respondent) is expecting to care for more than four children, Licensee (Respondent) shall stagger the schedules of her assistants, so an assistant is present at the earliest expected drop-off time and latest expected pick­ up time. Licensee (Respondent) shall not care for more than four children unless an assistant is present.

8. Licensee (Respondent) shall always operate within ratio and capacity limits, with the exception of having no more than two infants in care at any given time.

9. Licensee (Respondent) shall not drive a child to or receive another child from another family child care home or child care center with the intention of keeping a facility within ratio or capacity. Respondent shall not drive children to a public place, (e.g., a park) to avoid being out-of-ratio or capacity or to avoid licensing staff.

10. Licensee (Respondent) shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title 22 Regulation sections 80066 and 102416.1.



11. Licensee (Respondent) shall ensure that the facility is clean, safe, sanitary an in good repair at all times.

12. Licensee (Respondent) shall continue to follow the safe sleep regulations and train all staff on safe sleep requirements annually. Respondent shall provide all children with compliant sleeping areas.

13. For the duration of the probationary period, (Licensee) Respondent shall inform all current and prospective parent of children in the facility of the facility's probationary license by providing to the parents this Stipulation and the attached Accusation. Parents shall sign an acknowledgment indicating they have received a copy of the Stipulation and the attached Accusation. This parental acknowledgement shall be maintained in the corresponding child's file and shall be made available to the Department upon request.

During today's inspection 1 Technical Violation was issued. Report was reviewed with licensee Esperanza Correa. Notice of site visit and appeal rights were given.

NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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