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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215641
Report Date: 09/13/2021
Date Signed: 09/13/2021 10:42:31 AM

Document Has Been Signed on 09/13/2021 10:42 AM - 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:ESQUIVIAS FAMILY CHILD CAREFACILITY NUMBER:
406215641
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Alma EsquivasTIME COMPLETED:
10:50 AM
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On 9/13/2021 at 9:07am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 with Licensee, Alma Esquivas. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee wore a face covering. LPA observed the required documents posted inside of the home near the front door. There were two (2) children present (including Licensee's own child). Licensee stated that children over the age of 2 years are encouraged to wear face coverings while indoors. Child care services are provided in the the living room and dining room, LPA observed a variety of age appropriate toys, books, child sized furnishings, changing table and portable crib. There is fireplace in the living room which has a glass doors secured with a child safe lock. There are three (3) bedrooms and two (2) bathrooms in the home. The master bedroom with ensuite bath and second bedroom are off limits and made inaccessible with door knob locks. The third bedroom belongs to Licensee's children and is accessible to day care children. The bathroom used by children was observed to be clean and free of toxins.

Licensee stated there are no guns or ammunition in the home. LPA observed that cleaning products, medications and other items such as kitchen knives are stored inaccessible to children. Smoke and carbon monoxide detectors were tested at 9:13am and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a service date of 7/7/2021. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 3/20/21.

LPA observed the outdoor activity area in the front yard which is not fenced. Licensee stated that children are not allowed outside without adult supervision. LPA observed a variety of age appropriate equipment in good condition on the ground below the wooden deck. Licensee stated that there are no bodies of water on the property.

Licensee has current Pediatric CPR and first aid training expiring on 6/20/2022. Continued on 809-C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2021
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: ESQUIVIAS FAMILY CHILD CARE
FACILITY NUMBER: 406215641
VISIT DATE: 09/13/2021
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Licensee has met SB 792 immunization requirement. Licensee completed Mandated Reporter Training per AB 1207 in Spanish on 9/24/2020 and was reminded to renew the training every two (2) years. Facility roster and one child's file was reviewed and found complete.

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP and Individual Infant Sleep Plan (LIC9227) in Spanish. Licensee has a sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years. LPA provided the “Effects of Lead Exposure” brochure (PUB 515SP) in Spanish and reminded Licensee that the brochure must be given to all families at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. COVID19 Information for San Luis Obispo County can be found at www.emergencyslo.org/en/covid19.aspx. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email. Licensee stated that she receives training from Community Action Partnership of San Luis Obispo (CAPSLO).

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. Licensee stated that she understands that if a childre requires IMS she must gather documents and submit to the Department. 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: www.ada.gov/childqanda.htm

In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights (in Spanish) were discussed and left with Licensee, Alma Esquivas, whose signature on this form confirm receipt of these documents.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

This report was translated by Language Link translator #12920.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021
LIC809 (FAS) - (06/04)
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