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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 03:27:47 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/
DIRECTOR:		CATRINA MELENDEZ-SANTOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 710-7385
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:31 PM
MET WITH:Catrina Melendez TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On September 4, 2024, at 02:31 PM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Susana Martinez made a unannounced Case Management Inspection of the above mentioned Family Child Care Home (FCCH). LPAs met with Catrina Melendez, Licensee of the FCCH and explained the nature and purpose of the inspection. LPAs, in the company of Licensee toured the interior and exterior of the FCCH, in its entirety. Licensee stated that they are closed as of September 3, 2024 and will be re opening on September 9, 2024.

During the tour of the FCCH, at 2:03 PM, LPAs asked the licensee on where infants sleep within the facility. Licensee stated that they mostly sleep in cribs, but there is one child, C2, who naps on a folded twin mattress near the licensee in the living room. LPA advised licensee to halt placement of child on the mattress and go back to placing the child within a crib. At 1:56 PM, LPAs asked licensee for the safe sleep records of all the infants in care. Licensee stated that they were unaware of the fact that they needed to conduct 15 minute safe sleep checks for children who were over one year old, but under two years old. LPAs advised licensee to begin doing safe sleep documentation for infants under two years. LPAs provided the licensee with the FAQs regarding infants. LPAs also provided licensee with the title 22 regulations regarding safe sleep.

Two Type B Deficiencies are being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and CCR 102425(j)(2)(D) and 102425(a)(1) (refer to LIC 809-D). Licensee was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative Catrina Melendez.
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Aaliyah Zendejas
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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Document Has Been Signed on 09/04/2024 03:27 PM - It Cannot Be Edited


Created By: Aaliyah Zendejas On 09/04/2024 at 02:45 PM
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: MELENDEZ-SANTOS FAMILY CHILD CARE
FACILITY NUMBER: 566215781

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
102425(j)(2)(D)

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102425(j)The provider shall supervise infants... and adhere to the following requirements: (D)The provider shall check and document the following: (D)Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following
This requirement is not met as evidenced by:
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Licensee is to read the rules and regulations and FAQs to ensure that they know the infant safe sleep rules. Licensee is to send over two weeks worth of infant safe sleep checks to the department with the necessary documentation needed.
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Based on record review and interview, the licensee did not comply with the section cited above where licensee stated they were not documenting 15 minute safe sleep checks which poses a potential health, safety or personal rights risk to persons in care.
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Type B
09/04/2024
Section Cited
CCR102425(a)(1)

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102425 INFANT SAFE SLEEP(a)There shall be one crib or play yard for each infant who is unable to climb out of the crib or play yard.
(1) All cribs or play yards shall meet the United States Consumer Product Safety Commission safety standards.
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Licensee is to immediately cease placement of child on the mattress, and have the child sleep in a crib or play yard.
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Based on observation and interview, the licensee did not comply with the section cited above where licensee stated they were placing an infant under one year on a folded up twin mattress which poses 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.
SUPERVISOR'S NAME:Lissete Gonzalez
LICENSING EVALUATOR NAME:Aaliyah Zendejas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
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