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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215918
Report Date: 11/08/2021
Date Signed: 11/08/2021 01:54:34 PM

Document Has Been Signed on 11/08/2021 01:54 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FONSECA FAMILY CHILD CAREFACILITY NUMBER:
426215918
ADMINISTRATOR:YADIRA FONSECAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 757-1067
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Yadira FonsecaTIME COMPLETED:
02:05 PM
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A case management inspection was conducted by Licensing Program Analysts (LPAs) S. Mendoza-Ceja and D. Thompson who observed the following violations. In addition, LPAs toured the home inside and outside.

It was found that Licensee Yadira Fonseca allowed Mario Fonseca to move into the home prior to obtaining a criminal record clearance. Mario Fonseca was live scanned, but has not obtained a criminal record clearance with the Department. In addition, LPAs observed an unsecured trampoline in the backyard, Licensee stated the trampoline is used by her child and is not used by the day care children.


The following Type A deficiencies are cited according to CCR, Title 22, Division 12 for allowing Mario Fonseca in regards to Criminal Record Clearance and the unsecured trampoline. An exit interview was conducted, and Plan of Correction was reviewed and developed with the Licensee Fonseca. A copy of this report and appeal rights were discussed and left with Licensee.

A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation. Upon enrollment of a new child in a facility, the licensee shall provide to the parents or legal guardians of the newly enrolling child copies of any licensing report that the licensee has received during the prior 12-month period that documents any Type A citation.

LPAs observed the "Notice of Site Visit" posted.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2021
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 11/08/2021 01:54 PM - It Cannot Be Edited


Created By: Sylvia Mendoza-Ceja On 11/08/2021 at 12:35 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: FONSECA FAMILY CHILD CARE
FACILITY NUMBER: 426215918

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/09/2021
Section Cited
CCR
102370(d)1&(e)

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing... in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department or Violation of Section 102370(d) will result in a citation of a deficiency and an immediate assessment of civil penalties
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Correct Immediately.

Licensee shall submit a written plan of correction to Licensing for review.
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of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department. This requirement was not met as evidenced by: Review of the Licensing database and interview with Licensee who stated she did not receive a criminal record clearance letter prior to Mario Fonseca moving into the home. This poses an immediate risk to children in care. A $500.00 Civil Penalty is assessed.

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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:Ana Tolentino
LICENSING EVALUATOR NAME:Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/08/2021 01:54 PM - It Cannot Be Edited


Created By: Sylvia Mendoza-Ceja On 11/08/2021 at 01:08 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: FONSECA FAMILY CHILD CARE
FACILITY NUMBER: 426215918

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/08/2021
Section Cited
CCR
102417(d)

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Operation of a FCCH: The home shall provide safe toys, play equipment and materials.



This requirement was not met as evidenced by:
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Correct Immediately.

Licensee shall submit a written plan of correction to Licensing for review by 11/09/2021.
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Inspection of the trampoline and interview with licensee who stated the trampoline is not used by the day care children, Children in care are ages 6 months - 8 years of age. However, it is open and accessible to day care children which poses an immediate risk to children 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:Ana Tolentino
LICENSING EVALUATOR NAME:Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2021


LIC809 (FAS) - (06/04)
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