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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215480
Report Date: 10/05/2023
Date Signed: 10/05/2023 04:28:12 PM

Document Has Been Signed on 10/05/2023 04:28 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:TORRES FAMILY CHILD CAREFACILITY NUMBER:
406215480
ADMINISTRATOR:ANA ROSA TORRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 467-3273
CITY:SAN MIGUELSTATE: CAZIP CODE:
93451
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Ana Rosa TorresTIME COMPLETED:
04:30 PM
NARRATIVE
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On 10/5/2023, at 1:04 PM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection. LPA met with Ana Rosa Torres, and Benjamin De Alba, licensee's husband. The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 3 children and 3 infant napping in the garage/day-care room at the time of the inspection.

The main day care areas are living room, dining room, kitchen, bathroom, and garage/day-care room. The licensee stated the garage began been used for the day-care children in March of 2020. LPA advised the licensee the garage currently does not have a clearance for day-care use of the garage and is to remain off limits until the garage is cleared by the fire department.

LPA inquired on the adults who reside in the home. The licensee stated Ana Rosa Torres, licensee, Benjamin De Alba, licensee's husband, and Israel De Alba Torres, licensee adult son, who has not complete the criminal record clearance resides in the home. The licensee stated she received a letter of incomplete live scan submission from Guardian on June 20, 2023.

LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include second floor, the 3 bedrooms and 2 bathrooms secured with doorknob covers and gates. The backyard is completely fenced. LPA observed age appropriate toys, bikes, play structure and playhouses.

No bodies of water were observed. Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. Sampling of children's records were reviewed. The fire extinguisher was observed and was serviced January 6, 2023. There is a

THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: TORRES FAMILY CHILD CARE
FACILITY NUMBER: 406215480
VISIT DATE: 10/05/2023
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functioning carbon monoxide detector and smoke alarm that meets statutory requirements, were tested at 2:20pm and functioning at the time of the visit. Licensee is current with immunization required per SB 792. The last Safety drill was conducted July 6, 2023. Licensee is current with CPR and First Aid which expires October 1, 2024. Licensee completed the Mandated Reporter Training on October 13, 2022, that is required per AB 1207.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep" (PIN 20-24) and Effects of Lead Exposure. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov. LPA provided licensee with Cal Fire guidance for family day care homes.



Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish. Today, deficiency cited under Title 22 Division 12 Appeal rights given.

Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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Document Has Been Signed on 10/05/2023 04:28 PM - It Cannot Be Edited


Created By: Martina Jimenez On 10/05/2023 at 03:10 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: TORRES FAMILY CHILD CARE
FACILITY NUMBER: 406215480

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type A
Section Cited
CCR
102370(d)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview with licensee, and record review, revealed Israel De Alba Torres, licensee adult son, who has not complete the criminal record clearance, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2023
Plan of Correction
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Licensee is to submit a written statement, how licensee will prevent future incidents and live scan verification to CCLD by 10/6/2023, via email: Martina.Jimenez@dss.ca.gov
Type A
Section Cited
CCR
102423(a)(2)
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: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, and interview with the licensee who stated licensee began using the garage for the day-care children in March of 2020, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/06/2023
Plan of Correction
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Licensee is to submit a written statement, how licensee will prevent future incidents to CCLD by 10/6/2023, via email: Martina.Jimenez@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.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023


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