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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217483
Report Date: 12/17/2025
Date Signed: 12/17/2025 12:04:43 PM

Document Has Been Signed on 12/17/2025 12:04 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:MENDOZA GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
426217483
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
12/17/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Ofelia Mendoza GonzalezTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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On December 17, 2025 @ 9:15 AM, Licensing Program Analyst (LPA) Joaquin Mendez conducted an unannounced Case Management Inspection and capacity increase visit of the abovementioned Family Childcare Home (FCCH). LPA Mendez met with Ofelia Mendoza Gonzalez, licensee. 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 is the licensee, with two assistants (S1 and S2) and two (2) children in care. LPA notes one of the children belongs to the licensee. The licensee reports three (3) adults live in the home. LPA confirmed through Guardian website that three (3) adults have been cleared with a criminal record. Per Applicant, the operating hours will be Monday through Friday from 5:30 a.m. to 5:30 p.m. Applicant states she wants to care for children from 0 to 12 years of age.

The residence has three (3) bedrooms, two (2) bathrooms, a living room (furnished into daycare), kitchen, dining room, garage, and back yard. The areas to be used for childcare within the residence are the living room (furnished into daycare), dining room, one (1) bedroom (furnished for daycare), both restrooms (one in daycare room), and backyard. While the remainder of the home is excluded from care. LPA observed locks and doorknob covers on all remaining bedroom doors and garage, making these rooms inaccessible to children in care. LPA observed a gate preventing access to the kitchen. In the living room there is a fireplace, and it is locked with a gate to prevent access to children in care. LPA observed the residence to be clean and orderly. Additionally, the residence has spaced and ventilation for children in care.

All areas identified on the facility sketch were inspected. The home was inspected for safety, comfort,

Continue on LIC809C

NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2025
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 6
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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Document Has Been Signed on 12/17/2025 12:04 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 12/17/2025 at 11:34 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: MENDOZA GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217483

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/26/2025
Section Cited
CCR
102419(d)(1)

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(d) At the time of acceptance... the licensee shall provide the child's parent... with a copy of the notice...Parent's Rights, LIC 995A..., which acknowledges that the parent or...
This requirement is not met as evidenced by:
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Licensee will request parent to sign the LIC995 and send proof to LPA. Business card is left with contact information.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in C3 is missing the signed LIC995 which poses/posed a potential health, safety or personal rights risk to persons 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.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Joaquin Mendez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2025


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: MENDOZA GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217483
VISIT DATE: 12/17/2025
NARRATIVE
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cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the FCCH to be orderly and clean.

LPA reviewed children's records. The records are current and possessed emergency contact information and immunization records, among other relevant licensing documents and forms. However, C2 is missing the signed LIC995. The Licensee's records were also viewed and found to be complete.

· The Licensee has current Pediatric First Aid and CPR which expires, 11/06/2027.

· Applicant completed the Mandated Reporter Training 11/13/2025 and expires 11/13/2027.

· Applicant has proof of immunization per SB 792 against influenza, pertussis, and measles.

· LPA observed a regulation fire extinguisher in the FCCH, which was last serviced on 1/28/2025. LPA reminded the Licensee to service or purchase a regulation fire extinguisher yearly.

· When reviewing records LPA notes fire/disaster drill logged 10/10/2025 with (8) children present. LPA reminded the licensee that the disaster drills must be conducted every 6 months per regulation.

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: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: MENDOZA GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217483
VISIT DATE: 12/17/2025
NARRATIVE
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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.

Because the applicant Ofelia Mendoza Gonzalez 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).

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility. LPA completed a RSO profile in FAS on December 16, 2025.

On August 25, 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 fire clearance following an inspection completed at FCCH on October 13, 2025. Fire Clearance is granted with the special conditions noted below.

Special condition: the large family day-care was approved with the condition of maintaining the lime tree trimmed at all times. Upon conducting my initial fire inspection, the lime tree needed to be trimmed or removed to allow the proper means egress to evacuate in case of emergency. The lime tree is on the way from the secondary evacuation exit.

Today, a type B deficiency was cited under Title 22 Division 12 Appeal rights given. See LIC809D. A plan of correction is requested from the licensee and must be sent to LPA Mendez by the end of business

Continue on LIC809C

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

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: MENDOZA GONZALEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217483
VISIT DATE: 12/17/2025
NARRATIVE
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day 12/26/2025.

The home meets Title 22 of CCR provisional requirements for a Large Family Childcare license effective today. Effective date of license is today December 17, 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, Ofelia Mendoza Gonzalez in the licensee’s preferred language, Spanish.

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

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC809 (FAS) - (06/04)
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