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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426217218
Report Date: 01/09/2025
Date Signed: 01/09/2025 02:23:53 PM

Document Has Been Signed on 01/09/2025 02:23 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:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
426217218
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
01/09/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Elizabeth Jimenez TIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 1/9/2025 at 1:20 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management Inspection at the above Family Child Care Home. (FCCH) LPA met with Licensee/applicant, Elizabeth Jimenez and discussed the purpose of the inspection. Applicant/Licensee operates from Monday to Friday 6:00 AM to 5:00 PM and provides care to children aged 6 months to 10 years old. There are 6 children present under the care of Licensee Spouse/Assistant who arrived at the home during the inspection.

On 11/13/2024, Licensee/applicant submitted an application to Community Care Licensing (CCL) requesting a capacity increase from 8 to 14 day care children.
LPA and Licensee/applicant toured the home. This is a two story home, second floor includes 3 bedrooms and 2 bathrooms. The bottom of the staircase is barricaded with a baby gate to prevent children from accessing the second floor. The day care uses the first floor which include one bedroom for napping, one bathroom, the living room, dining/kitchen and the fenced side yard/patio.

On 1/3/2025, Santa Maria Fire Department granted the fire safety clearance. Fire extinguisher was serviced on 8/29/2024, carbon monoxide and smoke detectors were observed in the hallway of the home.
Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 426217218
VISIT DATE: 01/09/2025
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Pediatric CPR and First Aid expires on 5/25/2025 while Mandated Reporter Training certificate expires and on 3/3/2025.

Control of Property - Lease Agreement was verified. Because the applicant, rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149) for large FCCH license.

The home meets the requirements for a capacity increase from 8 to 14 children and license for large Family Child Care Home is effective today, 1/9/2025.

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

Exit interview conducted and report was reviewed with applicant/licensee, Elizabeth Jimenez.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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