<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566212195
Report Date: 03/05/2026
Date Signed: 03/05/2026 04:10:24 PM

Document Has Been Signed on 03/05/2026 04:10 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:BARRAZA FAMILY CHILD CAREFACILITY NUMBER:
566212195
ADMINISTRATOR/
DIRECTOR:		JUDITH BARRAZAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 889-2985
CITY:OXNARDSTATE: CAZIP CODE:
93030
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/05/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:36 PM
MET WITH:Judith BarrazaTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On March 5, 2026, 12:38PM Licensing Program Analyst (LPA) Cynthia Alvarez conducted an unannounced 3 year required inspection. LPA arrived at the FCCH and met with Licensee Judith Barraza; LPA and the Licensee discussed the nature and purpose of the inspection. Together both licensee and LPA conducted a tour of the home inside and out. At the time of the inspection, there were 6 children present. At 12:45PM Licensee called assistant to come back from lunch and to assist during the inspection. The assistant is cleared and associated to the FCCH.

The family childcare home (FCCH) is described as a 5-bedroom, 3-bathroom two-story home. LPA observed a gate at the bottom of the stairs making the entire second floor inaccessible. The licensee is currently living-room, dining room, downstairs bathroom and the enclosed backyard for childcare. LPA observed a gate at both ends of the kitchen, making it inaccessible to the children in care. LPA advised licensee that the facility sketch on file has the kitchen listed an area accessible to children. Licensee stated they had remodeled the kitchen in 2024 and had made the kitchen “off-limits” since then. LPA asked if they notified the department of the remodel. Licensee stated they did not. LPA reminded licensee that anytime there is a remodel done to the FCCH, they must notify the department prior to commencing the remodel. LPA asked if the children were present during the remodel, Licensee indicated that the children were present. LPA advised licensee to submit new facility sketch indicating the kitchen is now “off- limits” to the children. The FCCH has ventilation to afford for the children’s comfort. The bathroom used for childcare was found to be clean and sanitary, and free of harmful chemicals . The backyard was observed to have plenty shade and age-appropriate toys that are in good condition and varied. LPA observed a portion of the backyard had been made “off limits” to the children, licensee stated they are storing some items that were given to them and has made that area “off limits” to the children. LPA advised that anytime “off-limits” areas are modified, they must notify the department and update the facility sketch. LPA asked when the area was made “off limits” to the children, licensee stated since October 2025. LPA asked when they plan to remove the items and make the area accessible to children again, they stated they do not have a date scheduled. LPA requested for licensee to submit a new facility sketch stating the new “off limits” area of the backyard. The Licensee advised that there are no firearms and ammunition in the home, There are no bodies of water in the home.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Cynthia Alvarez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 12
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)
Page: 2 of 12
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195
VISIT DATE: 03/05/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Required licensing forms are predominantly posted in front of the FCCH. LPA did not observe any smoke or carbon monoxide detectors in the FCCH. Licensee stated they had forgotten to put them on again after the remodel. The licensee is reminded the FCCH must always have detectors in the home and to routinely check detector to ensure they have working batteries and are in operable condition. The FCCH has a regulation fire extinguisher on site which was serviced 3/3/26, Licensee was reminded to either service or purchase a regulation fire extinguisher annually.

LPA reviewed children's records. The records were found to be incomplete; 4 children’s records had outdated immunization records. LPA reminded licensee to obtain a copy of the most updated immunization record every time a child gets updated Furthermore, 1 record did not contain an emergency card. LPA reminded licensee that they need to keep an emergency card for every child enrolled. A review of the infant's present record, found that the licensee is not logging the 15 minute sleep checks. Licensee stated they thought that requirement was only for children up to 12 months. LPA indicated that they must log the sleep checks for children until the child turns 24 months, The FCCH's fire drill was present; the last drill was conducted on 1/9/26. The FCCH roster was present and found incomplete as only 1 child was listed on the roster and licensee has 13 children enrolled. LPA reminded licensee it is required to have the roster up to date. Licensee’s records were reviewed; Licensee’s Pediatric CPR and First Aid certification was expired; it expired 03/2024. Licensee’s Mandated Reporter training course also expired, it expired 03/2024. LPA also reviewed the assistant’s file and they had expired Mandated Reporter Training and Pediatric CPR/First Aid training was conducted online. LPA reminded licensee that CPR/ First Aid training must be done in person.

During the inspection, LPA observed licensee place C1 on a high chair, LPA observed child rocking back and forth trying to get off the chair. LPA advised licensee that they cannot place a child on a high chair that is designated to feed children, after further inspection, the high chair was found to be deigned for children up to 2.5 years of age. C1 is 5 years old. LPA advised licensee children cannot be place on chairs that are not designated for their age range. Licensee stated they had placed child on the chair to prevent them from attempting to go outside and because the assistant was busy changing other children, they needed to ensure the child was in place. LPA stated they cannot do that because it is a violation of C1's child's personal rights. Licensee stated they understood and would not place C1 again on that chair.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Cynthia Alvarez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC809 (FAS) - (06/04)
Page: 3 of 12
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195
VISIT DATE: 03/05/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
at 12:50PM Licensee stated they needed to step out to pick up additional children from school, LPA observed there was now 10 children in the FCCH and advised them that they cannot leave the assistant alone with the children as they would be over capacity. Licensee stated that A1 can stay and help with the children. LPA confirmed A1 is cleared and associated to the FCCH but did not have the requirements to be left alone with the children as they do not have pediatric CPR/ First Aid training or mandated reporter training. LPA advised that they cannot be left with the assistant. Licensee called parents of the children at school to notify them that they cannot pick them up and made alternate accommodations to to pick them up. Furthermore, licensee stated they pick up children from school everyday and leave C2 with the assistant. LPA confirmed C2 is cleared and associated to the FCCH but its not authorized to supervise the children as they do not have pediatric CPR/ First Aid training or mandated reporter training. Licensee stated they will have C2 complete the trainings as they assist in the FCCH every day.

License 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.

License 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.

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.

Continued on 809-C

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Cynthia Alvarez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC809 (FAS) - (06/04)
Page: 4 of 12
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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195
VISIT DATE: 03/05/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

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

LPA informed licensee that this report dated 3/5/26 document 1 Type A citations and 4 Type B citations which shall be posted for 30 consecutive days as there is/are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA informed the licensee to provide a copy of this licensing report dated 3/5/26 that documents a Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A Notice of Site visit was provided to the licensee, and it was advised that it needs to be posted for 30 days.

During today’s inspection 1 Type A, 4 Type B citations and 4 technical violations were given; Appeal Rights were provided to licensee

Exit interview conducted and report was reviewed with the licensee Judith Barraza.

NAME OF LICENSING PROGRAM MANAGER: Susana Martinez
NAME OF LICENSING PROGRAM ANALYST: Cynthia Alvarez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC809 (FAS) - (06/04)
Page: 5 of 12
Document Has Been Signed on 03/05/2026 04:10 PM - It Cannot Be Edited


Created By: Cynthia Alvarez On 03/05/2026 at 03:36 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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102423(a)(4)
Personal Rights
(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (4) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above as they placed a child on a high chair that was designed for children up to 2.5 years old, the child was 5 years old, licensee placed the child on the chair to retrain him which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/31/2026
Plan of Correction
1
2
3
4
LPA stated to licensee that they will be invited to an informal meeting at the RO office to discuss child care regulations at a a later day. LPA stated they will be notified of when the meeting will be scheduled and will receive a letter in the mail with the time and date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Alvarez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2026


LIC809 (FAS) - (06/04)
Page: 6 of 12
Document Has Been Signed on 03/05/2026 04:10 PM - It Cannot Be Edited


Created By: Cynthia Alvarez On 03/05/2026 at 03:36 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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.543
Licensure Requirements
Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above as they do not have a smoke detector or a carbon monoxide detector in the FCCH which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2026
Plan of Correction
1
2
3
4
LIcensee will purchase and install the smoke detector and a carbon monoxide detector in the FCCH. Licensee will send a video of the detectors intalled and testing them to ensure they are working to LPA at 805-689-4212 or to cynthia.alvarez@dss.ca.gov by the date noted above
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
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above as neither licensee or assistant had active mandated reporter trianing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2026
Plan of Correction
1
2
3
4
Licensee and assistant will take the mandated reporter training and will send a copy of the certiticate to LPA by the date stated above. to 805-689-4212 or to cynthia.alvarez@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Alvarez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2026


LIC809 (FAS) - (06/04)
Page: 7 of 12
Document Has Been Signed on 03/05/2026 04:10 PM - It Cannot Be Edited


Created By: Cynthia Alvarez On 03/05/2026 at 03:36 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: BARRAZA FAMILY CHILD CARE
FACILITY NUMBER: 566212195

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above as licensee and assistant did not have active pediatric CPR/ First Aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/22/2026
Plan of Correction
1
2
3
4
Licensee and asssistant will take the CPR/ First Aid training and will send a copy of the certificate to LPA by the date stated above to 805-689-4212 or to cynthia.alvarez@dss.ca.gov
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interviewand record review, the licensee did not comply with the section cited above as they do not have a current roster list of the chidlren enrolled which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2026
Plan of Correction
1
2
3
4
Licensee will complete the roster list and send a copy of the completed roster to LPA by the date stated above. To 805-689-4212 or to cynthia.alvarez@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Susana Martinez
NAME OF LICENSING PROGRAM MANAGER:
Cynthia Alvarez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2026


LIC809 (FAS) - (06/04)
Page: 8 of 12