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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215781
Report Date: 09/04/2024
Date Signed: 09/04/2024 03:27:14 PM


Document Has Been Signed on 09/04/2024 03:27 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:MELENDEZ-SANTOS FAMILY CHILD CAREFACILITY NUMBER:
566215781
ADMINISTRATOR:CATRINA MELENDEZ-SANTOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 710-7385
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:14CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Catrina MelendezTIME COMPLETED:
02:30 PM
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On September 4, 2024 at 1:15 PM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Susana Martinez made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPAs met with Licensee Catrina Melendez to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office by phone on 08/30/2024. LPAs toured the interior and exterior of the home, as well as the room where the infants sleep and the incident occurred. At time of inspection there were no children in care as Licensee closed day-care for a week.

On 08/26/2024 an incident occurred at the home between 10:18 AM and 10:30 AM. Licensee states that a child (C1) went down for a nap around 9:50 - 10 AM. Licensee then checked on child at 10:18 AM and the child was fine. Licensee went to check on child at 10:30 AM and the child was unresponsive. The licensee began to perform CPR while husband dialed 911. Licensee continued to do CPR until officers arrived and took over. Licensee states that five minutes after paramedics arrived they notified the parent of the child.

LPAs reviewed facility roster and children's files. During today's inspection LPA's conducted record review and obtained copies of sleep logs, children's roster, and children's files.

Due to insufficient information available at this time, the incident needs further investigation.

No deficiencies were issued during today's inspection.

Exit interview was conducted and report was reviewed with Licensee Catrina Melendez..
SUPERVISOR'S NAME: Lissete GonzalezTELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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