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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215081
Report Date: 09/23/2024
Date Signed: 09/23/2024 04:18:43 PM

Document Has Been Signed on 09/23/2024 04:18 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:JIMENEZ FCC AKA LUPITA'S DAYCAREFACILITY NUMBER:
406215081
ADMINISTRATOR/
DIRECTOR:		IRMA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 423-9289
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
09/23/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:54 PM
MET WITH:Irma JimenezTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joaquin Mendez made an unannounced 3year annual visit to the home at 1:56pm. LPA met with Licensee, Irma Jimenez. A tour of the home was made both inside and outside. The applicant will use the living room, dining room, hall bathroom, and outdoor front covered patio for the day care. LPA observed locks on bedrooms doors and the door to the backyard making the areas inaccessible to day-care children. At the time of inspection one bedroom was open belonging to S1. At the home was the licensee, assistant and nine (9) children in care. There are three (3) adults living in the home and three (3) adults are cleared through the Guardian website.

LPA observed the day care area to be clean and orderly.

· LPA observed chemicals (Clorox spray bottle) on a dresser in the hall in front of the bathroom.


A type B deficiency is cited (see LIC809-D). Licensee immediately removed the bottle and secured it with rest of the chemicals and cleaning supplies in a locked shed in the backyard.
· LPA observed (Crest4kids) toothpaste bottles in a drawer in the bathroom. LPA advised the licensee that due to the warning label must be kept out of reach of children.
  • Sharps are on top of the refrigerator inaccessible to children.
· LPA observed age-appropriate books, toy, games, tables, and chairs. LPA reminded licensee to replace toys and furniture as needed when the quality of play structures a harmful to children in care.
· LPA observed the off-limits areas which include the two (2) bedrooms and are made inaccessible to children in care by way secure locks on doors. LPA noted that S1’s bedroom was open and after thorough inspection was found to have medication in a drawer belonging to S2. A type B deficiency is cited due to exposed medications could pose harm when exposed to children in care. Meds ex. Saline nasal drops. (See LIC809D).
Continue on LIC809C pg2
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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 09/23/2024 04:18 PM - It Cannot Be Edited


Created By: Joaquin Mendez On 09/23/2024 at 03:19 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: JIMENEZ FCC AKA LUPITA'S DAYCARE
FACILITY NUMBER: 406215081

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in there was cleaning compounds (Crest toothpaste and Clorox spray). Additionally S1's bedroom bedroom was accessible at the time of inspection with medications in accessible area which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2024
Plan of Correction
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LPA observed Licensee immediately remove the items and make them inaccessible to children in care. Licensee also securley locked bedroom door. Licensee will provide a written statedment by the end of business day 10/03/24. In the statement the Licensee will state what plans of corrections will be made so this does not happen again. The POC will be emailed to joaquin.mendez@dss.ca.gov
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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


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: JIMENEZ FCC AKA LUPITA'S DAYCARE
FACILITY NUMBER: 406215081
VISIT DATE: 09/23/2024
NARRATIVE
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· The backyard is locked and in-accessible to children in care. Licensee stated she does not use the backyard as part of the Day Care.
· LPA observed the front yard covered patio play area to be in use and secured with wooden fencing all around. LPA notes No bodies of water were observed.
· Licensee stated that there are no weapons/ammunition in the home.
· The fire extinguisher was observed with a last service date 4/08/2024. LPA reminded licensee to replace or service fire extinguisher every year.
· There is a functioning carbon monoxide and smoke combination alarm that was tested a 2:15 pm, in the home, that meets statutory requirements, and are functioning at the time of inspection.

LPA reviewed licensee’s records.
· Mandated reporter certificate 6/22/2025. LPA reminded licensee to complete Mandated Reporter Training every (2) two years.
· CPR certificate expires 6/02/2026.
· Licensee is current with immunization required per SB 792.
· There is Safety drill recorded or conducted and documented. Last date was 8/30/2024 at 3:59pm with 9 children present.
· Children's records were reviewed and found to be complete and current. LPA reminded Licensee the importance of maintaining license related documents for all children in care.
· LPA reviewed the facility roster.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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
Continue on LIC809C pg3
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: JIMENEZ FCC AKA LUPITA'S DAYCARE
FACILITY NUMBER: 406215081
VISIT DATE: 09/23/2024
NARRATIVE
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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 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.

Licensee Irma Jimenez does not provide Incidental Medical Services (IMS).
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the LICENSEE Irma Jimenez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 9/20/2024.

Type B Deficiency is being cited based on LPA observation and interviews reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed in preferred language, Spanish with the Licensee Irma Jimenez.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Joaquin Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
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