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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216363
Report Date: 07/18/2022
Date Signed: 07/18/2022 12:18:45 PM

Document Has Been Signed on 07/18/2022 12:18 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PERKINS FAMILY CHILD CAREFACILITY NUMBER:
406216363
ADMINISTRATOR:JUANETTA PERKINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 712-9611
CITY:PASO ROBLESSTATE: CAZIP CODE:
93466
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
07/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Juanetta PerkinsTIME COMPLETED:
12:30 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
This is a change of location, previous facility number 406213506.

On July 18, 2022 at 11:30 AM , Licensing Program Analyst (LPA) Francisco Pedroza conducted an announced inspection to conduct a prelicensing change of location Inspection. LPA met with licensee Juanetta Perkins. Licensee provided LPA a tour of home inside and out. There was licensee's two (2) foster children in care at the time of the inspection.

Licensee has a single story three (3) bedroom home. Licensee will be using the living room, one (1) restroom, sun room and the back yard for children in care. The kitchen, bedrooms, and garage will be off-limits. LPA did not observe any toxins/hazardous items accessible to children. Licensee stores the knives in the top cabinet in the kitchen making it not accessible to children. LPA observed a 2A10BC fire extinguisher mounted on the wall with a service date for 12/30/2021. LPA observed a fire place in the living room with a screen preventing children from having access. There was age appropriate toys and day-care equipment in the home and sun room. The backyard is enclosed with a wooden fence. LPA observed the back yard has age appropriate toys and structures. LPA observed that licensee has an outdoor storage unit. LPA advised the storage must be secured at all times. Licensee advised they do not have firearms or live ammunition in the home.

Licensee advised that they understood and did not require LPA to review the required licensing forms. Licensee's Mandated Reporter certificate expires on 3/10/23. Licensee's Pediatric CPR/First-Aid expires on 5/12/24. The facility received an approved fire clearance on 7/12/22.

No deficiencies cited during this inspection. License to operate a large Family Child Care facility is effective today 7/18/2022.

Continued on 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2022
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 2
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: PERKINS FAMILY CHILD CARE
FACILITY NUMBER: 406216363
VISIT DATE: 07/18/2022
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
Applicant 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant 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 [applicant, licensee, or facility representative] 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information , see PIN 22-02-CCP. 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

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisco Pedroza
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2