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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216264
Report Date: 03/02/2023
Date Signed: 03/02/2023 12:15:16 PM

Document Has Been Signed on 03/02/2023 12:15 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:
426216264
ADMINISTRATOR:YADIRA FONSECAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 757-1067
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
03/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Yadira FonsecaTIME COMPLETED:
12:13 PM
NARRATIVE
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On March 2, 2023 at 10:07 AM, Licensing Program Analyst (LPA) Austin Rios and (LPA) Mayrose Breault conducted an unannounced Case Management inspection as increased unannounced visits to the facility are to to be conducted as part of the compliance plan for two years. LPAs met with licensee Yadira Fonseca and advised the purpose of the inspection. There were 10 children in care at the time of the inspection with licensee and two staff. Children were observed in the living room with the two assistants at the time of arrival. There was a gate at the bottom of the stairs preventing children from having access. A walk through tour of the home was conducted with licensee. The facility was observed to be orderly. The back yard has age appropriate toys and day care equipment and no toxins or hazardous items were observed.

All adults in the home are finger print cleared. Licensee Mandated reporter training certificate is on file with an expiration date of 4/17/2023. Licensee has CPR on file expiring 1/1/2024, Licensee attended the family child care home orientation as part of compliance plan on 3/30/2022. Licensee has removed trampoline to inaccessible area. Licensee previously submitted a written plan on how she will comply with the regulations. Licensee did not have LIC 9224 for each child in care in the file from previous conference in office on 3/21/2022. A type B deficiency is being cited on attached 809d, Health and Safety Code section 1596.8595 (d)(1)(4).

Exit interview conducted with licensee Yadira Fonseca. Licensee was reminded of the compliance plan to be followed and always maintaining proper supervision while the children are in the backyard too. LPA provided licensee with the Notice of Site visit LIC 9213.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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 03/02/2023 12:15 PM - It Cannot Be Edited


Created By: Austin Rios On 03/02/2023 at 11:56 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: FONSECA FAMILY CHILD CARE
FACILITY NUMBER: 426216264

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/02/2023
Section Cited
HSC
1596.859(d)(1)(4)

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Posting licensing report by child care facility or home; duration of posting...
(d)(1) A licensed child day care facility shall provide to the parents or legal guardians of each child ... copies...pertaining to a conference...
(4) The licensee shall keep verification of receipt in each child's file.

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Licensee shall submit to LPA Maryrose Breault a picture of all signed LIC 9224 forms for all children enrolled by 3/16/2023 to 805 635 5097.

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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:Austin Rios
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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