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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215473
Report Date: 08/13/2025
Date Signed: 09/12/2025 10:04:48 AM

Document Has Been Signed on 09/12/2025 10:04 AM - 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:PAZ FAMILY CHILD CAREFACILITY NUMBER:
426215473
ADMINISTRATOR/
DIRECTOR:		JOSEFINA PAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 268-3217
CITY:GUADALUPESTATE: CAZIP CODE:
93434
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/13/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Josefina PazTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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This report is amended on 9/10/2025 at 12:00 PM.
Licensing Program Analyst Joaquin Mendez conducted an unannounced 3 year Required Annual/Random inspection of the abovementioned Family Childcare Home (FCCH). LPA met with Josefina Paz, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. This is a single-story home which consists of three (3) bedrooms, two (2) bathrooms, living room, kitchen, dining room, garage and fenced backyard with covered patio. LPA notes that in today’s inspection are 7 children in care with the licensee and one assistant (S1).

All areas identified on the facility sketch were inspected. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children.

Areas used by children included: Two (2) bedrooms, kitchen, living room/dining room, bathroom, and backyard.

Off limit areas included: the licensee’s bedroom, and (1) bathroom. LPA observed locks on the bedroom doors making the licensee’s bedroom and bathroom inaccessible to children. It should be noted that access to the garage is through the kitchen and is locked at the time of inspection.

The applicant states that she will provide food for children in care. There are age-appropriate toys and napping equipment on the premises.
· Knives are stored out of children’s reach and are inaccessible to children.
· The required fire extinguisher 2A10BC was Serviced on July 1, 2024 (See LIC809D). LPA reminded the
NAME OF LICENSING PROGRAM MANAGER: Maria Mueller
NAME OF LICENSING PROGRAM ANALYST: Joaquin Mendez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2025
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 08/13/2025 12:19 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 08/13/2025 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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in [2] out of [2 counts] (scissors and a needle with thread are found accessible) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2025
Plan of Correction
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The licensee removed the items from accessability. Licesensee will write a POC what steps will be taken to prevent dangerous items being left accessible to children.
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, interview, and record review, the licensee did not comply with the section cited above in [2] out of [2 counts], the licensee and S1 do not have a current Mandatred reporter training certificate, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2025
Plan of Correction
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The licensee will send a copy of the required certification to LPA. Bussiness card left with information required to submit required forms. Licensee will write a POC, stating what she will do to always be in compliance with current required certifications.
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: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 08/13/2025 12:19 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 08/13/2025 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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in [2] out of [2 count] of persons (the licensee and S1) do not have current immunization, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2025
Plan of Correction
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The licensee will correct this and send confirmation LPA Mendez via email or text. The licensee will write a POC stating what process she will impliment in order to remain in compliance.
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.
Maria Mueller
NAME OF LICENSING PROGRAM MANAGER:
Joaquin Mendez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2025


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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473
VISIT DATE: 08/13/2025
NARRATIVE
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Licensee to either service or purchase a regulation fire extinguisher annually.

· The combination smoke and carbon monoxide detector were tested at 10:26 AM and was functioning at the time of the visit.


· First Aid and emergency kits are available.
· Required forms are predominantly posted on the wall of the FCCH's room. LPA reminded the Licensee the importance of maintaining accurate records and having documents readily available.
· The home maintains working telephone services by cellular phone. The LPA notes the licensee is adding her spouses personal cell phone number (805)354-3714 to be included in her file. LPA advised the licensee to complete LIC279 and include any and all changes and to submit them by mail to the regional office.
· The home was clean, orderly. However, in the bathroom used for children the LPA observed scissors and a needle with thread in the bathroom drawer accessible to children in care. (See LIC809D).
· Medication in the home is stored, inaccessible to children.
· LPA observed cleaning compounds stored in an elevated cabinet, inaccessible to children.
· Toys, furniture, and equipment observed in the FCCH were in satisfactory condition and age appropriate. LPA reminded the Licensee of the importance of maintaining clean and safe structures for children in care.

· The Licensee stated that there are no weapons/ammunition in the home.

· No bodies of water were observed on site.

LPA and the licensee together toured the outdoor play area. LPA advised the licensee children must never be unsupervised while the children are at the play area. The backyard is enclosed by wooden fencing. The ground consists of concrete and grass for the comfort of children.

· LPA observed the backyard outdoor play area to be safe with age-appropriate toys, games etc. The backyard is adequately fenced. LPA advised the licensee to make daily checks of all play structures prior to use.

· LPA observed in the backyard a baby walker. The licensee removed the baby walker and stated that the children do not use it. However, the LPA explained that this item is no longer allowed (See LIC809D). LPA will print out examples of items no longer allowed in an FCCH for reference purposes

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

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473
VISIT DATE: 08/13/2025
NARRATIVE
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and give to the licensee.

· The exit gate is observed to have safety latches for security.

· LPA observed an inaccessible area of the backyard secured from children. In the inaccessible area there are tools and the trash cans.

Children’s roster and records were reviewed. Records were current.

The Licensee's and employee records are found to be missing items noted below and incomplete.

· CPR and First Aid certifications expired on 6/2025 (see809D).

· The mandated reporter training certificate is missing, that is required per AB 1207. (see LIC809D)

· The licensee stated she does not hold a foster family license.

· The last Safety drill was conducted 02/17/2025.

· The Licensee is not current with immunization required per SB 792. (see LIC809D)

· The licensee provided the insurance information. LPA advised the licensee to keep a copy in her file for future review.

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.

The licensee, Josefina Paz provided proof of control of property.

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 Childcare 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.

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

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
Page: 8 of 9
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: PAZ FAMILY CHILD CARE
FACILITY NUMBER: 426215473
VISIT DATE: 08/13/2025
NARRATIVE
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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.

The Licensee is not providing Incidental Medical Services (IMS). 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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE, Josefina Paz confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on August 06, 2025.

A notice of site visit was given to Licensee 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, Josefina Paz in the preferred language, Spanish.

During today's inspection 3 type B citations and 2 Technical violations were issued (see LIC809D and LIC9102 respectively). Plan of corrections must be submitted by the licensee by the end of business day August 22, 2025. LPA observed licensee post the Notice of Site visit.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

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

DATE: 08/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2025
LIC809 (FAS) - (06/04)
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