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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566217251
Report Date: 05/21/2026
Date Signed: 05/21/2026 01:20:47 PM

Document Has Been Signed on 05/21/2026 01:20 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:CRUZ FAMILY CHILD CAREFACILITY NUMBER:
566217251
ADMINISTRATOR/
DIRECTOR:		CRUZ RODRIGUEZ, LIVIERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 980-8545
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
05/21/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:46 AM
MET WITH:Livier Cruz TIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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On May 21, 2026, Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Annual/Random inspection at the above mentioned Family Child Care Home (FCCH). LPA met with licensee Livier Cruz and informed them the purpose of the inspection. At the time of the inspection 2 children were present.

LPA observed required postings to be located in the living room of the FCCH. LPA observed the facility to have a combination smoke and carbon monoxide detector which was tested at 9:50AM and found in working order. The FCCH has a regulation fire extinguisher. LPA reminded license to either service or purchase a regulation fire extinguisher annually.

LPA in the company of the licensee toured the interior and exterior of the FCCH. LPA notes the facility is currently using the living room, 1 bathroom, and backyard for child care purposes. LPA observed the living room to have sufficient space and ventilation for children in care. LPA observed the living room to have a fire place that is secured with a child proof lock. LPA observed the hallway bedrooms to be made inaccessible with a child proof gate and locks. LPA observed the kitchen is made inaccessible with child proof gates. LPA observed sharps and cleaning products to be located in a secured kitchen cabinet. LPA observed the bathroom used for child care purposes to be clean. LPA reminded licensee it is their responsibility to ensure all hygiene products are inaccessible to children in care.

LPA observed the outdoor area to be completely enclosed. LPA observed the yard to have age appropriate toys and equipment. LPA observed the backyard to be free of hazards as well. No bodies of water were
CONTINUED LIC 809C
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2026
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.

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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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 566217251
VISIT DATE: 05/21/2026
NARRATIVE
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observed on site.

LPA reviewed files of children. LPA notes all children had incomplete files. 1 Type B deficiency is being issued as a result on the attached LIC 809D. LPA informed licensee all children in their care must have a complete file. Licensee stated they are not caring for infants at this time, there for no Safe Sleep Checks were reviewed. Licensee's Pediatric CPR/First Aid expires on 10/11/26. Licensee's Mandated Reporter Training (AB 1207 compliant) expires 10/15/26 .LPA reminded licensee that it is their responsibility to maintain current certifications and training. Licensee informed LPA Adult 1 (A1) has been staying at the FCCH for 2-3 weeks. LPA notes A1 does not have CRC and 1 Type A deficiency and Civil Penalty is being issued on the attached LIC 809D.

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 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps
families obtain child care by connecting them to child care providers and Resource and Referral Agencies
(R&Rs) throughout California.


CONTINUED LIC809C
NAME OF LICENSING PROGRAM MANAGER: Ana Tolentino
NAME OF LICENSING PROGRAM ANALYST: Giovani Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 566217251
VISIT DATE: 05/21/2026
NARRATIVE
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During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the
facility and LPA completed the RSO profile in FAS.

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.

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. 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.

1 Type A and 1 Type B deficiency were issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.A violation regarding Criminal Record Clearance warrants an immediate civil penalty and is hereby assessed, see LIC421BG.

Upon receipt, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to Licensee).

Exit interview conducted and report was reviewed with the licensee Livier Cruz.


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

DATE: 05/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/21/2026 01:20 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 05/21/2026 at 12:17 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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 566217251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review , the licensee did not comply with the section cited above in A1 staying at the home which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/21/2026
Plan of Correction
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Licensee will have A1 obtain criminal record clearance
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Giovani Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/21/2026 01:20 PM - It Cannot Be Edited


Created By: Giovani Gonzalez On 05/21/2026 at 12:17 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: CRUZ FAMILY CHILD CARE
FACILITY NUMBER: 566217251

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102421(a)
Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above in not having complete files for children enrolled which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2026
Plan of Correction
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Licensee will complete children's files and provide proof of completion to LPA via email at giovani.gonzalez@dss.ca.gov.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Ana Tolentino
NAME OF LICENSING PROGRAM MANAGER:
Giovani Gonzalez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2026


LIC809 (FAS) - (06/04)
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