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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216033
Report Date: 04/23/2025
Date Signed: 04/23/2025 03:52:42 PM

Document Has Been Signed on 04/23/2025 03:52 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 FCC AKA CHAVEZ'S DAY CAREFACILITY NUMBER:
566216033
ADMINISTRATOR/
DIRECTOR:		RIGO CHAVEZ, ROCIO PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 645-2733
CITY:OXNARDSTATE: CAZIP CODE:
93036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
04/23/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:32 PM
MET WITH:Rocio Perez & Rigo ChavezTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
NARRATIVE
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On April 23, 2025, at 12:27 PM, Licensing Program Analyst (LPA) Fernando Hernandez conducted an unannounced Annual Random inspection at the above Family Childcare Home (FCCH). LPA met with both Licensees, Rocio Perez & Rigo Chavez. LPA discussed the purpose of the inspection. FCCH operating hours are Monday to Friday from 5:30 AM to 5:00 PM, provides care to children between 2 months to 13 years old.

During the inspection, LPA and Licensee(s) toured the inside and outside of the home. LPA observed (12) children in care under the supervision of both licensee(s) and (2) assistants. LPA notes the home is a two-story home. The Accessible area in the home includes, backyard, (1) bathroom, (1) bedroom for napping, and playroom for daily activities. LPA notes the (4) bedroom(s), kitchen, dining room, garage, living room and (2) bathroom(s) remain inaccessible to children. The required licensing forms are posted in a prominent location. Filtered water is accessible to children in care by means of individual water cups. LPA observed age-appropriate toys and equipment, cots and play pens inside the home. Knives are kept elevated in the kitchen made inaccessible to children in care while the cleaning materials are stored outside in a storage shed which is locked and made inaccessible to the children in care. CONTINUED ON LIC809-C Page 2
NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2025
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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Document Has Been Signed on 04/23/2025 03:52 PM - It Cannot Be Edited


Created By: Fernando Hernandez On 04/23/2025 at 02:10 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: CHAVEZ FCC AKA CHAVEZ'S DAY CARE
FACILITY NUMBER: 566216033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above in 2 of 2 assistances did not have a completed mandated reporter training certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2025
Plan of Correction
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Licensee shall send LPA photos of Mandated Reporter training certificate for both assistants to LPAs email Fernando.hernandez@dss.ca.gov by 05/03/2025
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above in 1 out 2 assistants did not have required immunizations within the person's personnel record which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2025
Plan of Correction
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Licensee(s) shall send LPA Hernandez photos of Assistant(s) immunization records to maintain within person's personnel records via email fernando.hernandez@dss.ca.gov by 05/03/2025
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Fernando Hernandez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2025


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: CHAVEZ FCC AKA CHAVEZ'S DAY CARE
FACILITY NUMBER: 566216033
VISIT DATE: 04/23/2025
NARRATIVE
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LPA observed the back yard to be completely fenced by a concrete wall. The bathroom for children’s use was observed to be free of toxins. Licensee confirmed there are no firearms and ammunition in the home. LPA notes during inspection an unknown adult arrived in the home. Licensee(s) stated the adult is licensees sister who is visiting for a week. LPA informed Licensee(s) that a follow up inspection will be conducted to verify the uncleared adult is not present within the home.

LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 05/22/2026 while the Mandated Reporter Training Certificate expires on 03/10/27. LPA reminded Licensee that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher (2A10BC) was observed with a purchase date of 06/24/24. LPA reminded licensee that it is their responsibility to purchase or service fire extinguisher annually. A Carbon monoxide and smoke combination detector was tested and found functional at 12:45PM. The (FCCH) conducts a fire and disaster drill every six months and last drill was conducted on 01/03/2025.
The children’s files were reviewed and found complete. Reminder, all newly enrolled children to have complete files. Facilities current roster of children was reviewed by the LPA during inspection with all children present during the inspection noted in the roster. Licensee checks and documents napping infants every 15 minutes, the Individual Safe Sleep Plan is completed for infant aged 0-12 months. No bodies of water were observed.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

Continued on LIC809-D Page 3

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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: CHAVEZ FCC AKA CHAVEZ'S DAY CARE
FACILITY NUMBER: 566216033
VISIT DATE: 04/23/2025
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee, was reminded that all adults 18 and over living or working in the home, 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.

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.

LPA also informed licensee, 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.

Continued on LIC809-C Page 4

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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: CHAVEZ FCC AKA CHAVEZ'S DAY CARE
FACILITY NUMBER: 566216033
VISIT DATE: 04/23/2025
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This facility does not provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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

During the exit interview, the LICENSEE, Rigo Chavez & Rocio Perez confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today’s inspection (2) Type B deficiencies and (1) Technical Assistance were cited (See 809-D for more details).

Notice of Site Visit was issued and must be posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Rocio Perez & Rigo Chavez

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Fernando Hernandez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC809 (FAS) - (06/04)
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