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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216091
Report Date: 06/01/2021
Date Signed: 06/01/2021 03:37:22 PM

Document Has Been Signed on 06/01/2021 03:37 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:MONTANO FAMILY CHILD CAREFACILITY NUMBER:
406216091
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
06/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Valerie MontanoTIME COMPLETED:
03:45 PM
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On 6/1/2021 at 2:00PM, Licensing Program Analysts (LPAs) Melissa Stewart and Francisca Velazquez conducted an announced Pre-Licensing Inspection with applicant, Valerie Montano. LPA conducted a Pre-screening with Applicant prior to entering the home. All responses indicated non COVID-19 exposure. Licensee's infant and 9 year old child were also present during the inspection. All adults wore face coverings during the inspection. This is a five (5) bedroom, three (3) bathroom home. LPAs observed signs posted in the window near the front door regarding COVID19 symptoms and preventative measures. There is a sign in binder, hand sanitizer, and no touch thermometer on a table under the covered porch outside the front door of the home.

Applicant stated that she will post required licensing documents inside the front entry of the home. The main indoor activity area is located in bedroom number one (1). LPA observed child sized table and chairs and age appropriate toys. Bedroom five (5) is a spare bedroom with a single bed, dresser and an en suite bathroom. Applicant stated that this room will be accessible to children if they need a quite space to rest or do homework. Licensee has a dining room table, chairs and a high chair in the dining area. There are couches in the living room which leads into the kitchen. Knives are stored in a drawer with a metal latch and lock. There is a child sized table located in the kitchen. LPA observed the 2 A10 BC Fire Extinguisher mounted in the kitchen and serviced on 2/1/2021. Three (3) additional bedrooms are off limits to children in care and will be occupied by residents of the home or kept locked during day care hours. The garage and washroom are made inaccessible to children by a latch at the top of the door. Both bathrooms accessible to children were observed to be clean and free of toxins. Cleaning supplies or products labeled "keep out of reach of children" are stored in drawers or cabinets with metal latches. Applicant stated there are no guns or ammunition stored in the home. Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2021
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: MONTANO FAMILY CHILD CARE
FACILITY NUMBER: 406216091
VISIT DATE: 06/01/2021
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The home is equipped with working carbon monoxide detector and smoke detector. The backyard is completely fenced and no bodies of water were observed. Applicant has a patio table and chairs along with two patio umbrellas for shade. LPAs observed activity mat and hula hoops outside.

Applicant and additional adult resident have a criminal record clearance and proof of negative TB test. Applicant has met immunization requirement per SB 792 and completed the AB 1207 Mandated Reporter Training on 2/24/2021. Preventative Health and Safety course was completed on 3/18/2021, Pediatric CPR/first aid is current (expires 2/5/2023). Control of property documents are on file. Applicant does not have liability insurance and was reminded that parents must sign a waiver for the liability insurance (LIC 282 provided). Applicant submitted a completed child care program COVID19 Self Assessment which was also reviewed today.

The following was discussed with the applicant:

  • All adults living and working in the home shall be made of aware of the Department’s inspection authority.
  • Individuals who are 18 years of age or older living or working in the home, must obtain a criminal record clearance. Failure to obtain the Criminal Record Background Check clearance prior to initial presence in the home will result in an immediate Civil Penalty in the amount of $100.00 (or more per day).
  • In the absence of the Licensee, a qualified adult must be present supervising the children. A qualified adult is an individual who has verification of current Pediatric CPR & First Aid certification, TB clearance, immunizations, and a valid criminal record clearance associated to the facility license.
  • A current roster of children enrolled must be available for review and maintained for a period of three years, even after children are no longer attending the facility.
  • Small FCCH capacity regulation reviewed and chart provided.
  • The fire extinguisher type 2A10BC must be serviced or replaced annually. Smoke and carbon monoxide detectors should be tested and batteries replaced as needed.
Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
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: MONTANO FAMILY CHILD CARE
FACILITY NUMBER: 406216091
VISIT DATE: 06/01/2021
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  • Changes in the home should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if Licensee moves to another address.
  • Reporting Requirements: Any unusual incidents, exposure to communicable diseases or injuries which occur while in the care of the family child care provider must be reported to the Department office within 24 hours via telephone and mailed to the Department office within seven (7) days in writing (please use LIC 624b). Mandated reporter requirements for suspected child abuse were reviewed and explained.
  • Fire and safety drills must be performed at least every six months and documented for review by the Department.
  • Smoking is prohibited in a Family Child Care Home, 24/7.
  • Children and Staff records, to be maintained and updated, must be available for review by the Department, see LIC311D.
  • Prohibited equipment shall not be accessible during child care operating hours (examples: infant bouncers, walkers, Johnny Jumpers, exersaucer chairs or inclined sleeping devices).
  • Regularly check the Consumer Product Safety Commission website https://www.cpsc.gov/ regarding product recalls. Always read and abide by the manufacturers directions which specify the age recommendations for toys and furnishings used by children.
  • Forms/Records to Keep in Your Family Child Care Home (LIC 311D) and forms to be posted: LIC610A Emergency Disaster Plan, PUB394 Notification of Parents Rights Poster, Facility License were discussed with the applicant. LPA advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov
  • 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: http://www.ada.gov/childqanda.htm
  • Infant Safe Sleep regulations and Infant Individual Sleep Plan (LIC9227) was explained and discussed.
Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Melissa K Stewart
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
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: MONTANO FAMILY CHILD CARE
FACILITY NUMBER: 406216091
VISIT DATE: 06/01/2021
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  • California Department of Public Health COVID-19 guidelines for child care programs shall be followed at all times.
  • Title 22, Division 12 regulations for Family Child Care Home can be accessed on-line at www.cdss.ca.gov. Applicant subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.
The home meets Title 22, Division 12 requirements of a small Family Child Care Home. License is effective today, 6/1/2021.

Exit interview was conducted with Applicant, Valerie Montano, during which appeal rights were explained. Applicant indicated that she does not have any questions at this time. A copy of this report and appeal rights were discussed and left with Applicant whose signature on this form confirm receipt of these documents.

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

DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
LIC809 (FAS) - (06/04)
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