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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216433
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:29:05 PM

Document Has Been Signed on 12/07/2022 03:29 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:AVALOS FAMILY CHILD CAREFACILITY NUMBER:
406216433
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/07/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ricarda Avalos CalderonTIME COMPLETED:
12:21 PM
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On 12/07/2022, Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced Pre-licensing Inspection of the residence and met with Applicant Ricarda Avalos Calderon. LPA informed Applicant of the nature and purpose of the inspection. LPA notes, no children present during this inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 5AM to 5PM, Monday- Friday. The Applicant also Informed LPA of the intention to provide care for children 0 months to 13 years of age. Four (4) adults are listed in the application and four (4) adults are cleared and associated to facility.

LPA toured the interior of the residence with the Applicant. The residence is a single story, three bedroom, two bathroom home. Applicant informed LPA that the home's living room, dining area, kitchen and bathroom will be used for child care services. Meanwhile, all three (3) bedrooms, one (1) bathroom, garage and outdoor yard will be inaccessible to the children in care. LPA observed all bedrooms have door safety knobs making them inaccessible. LPA observed the living room to have spacing and ventilation for children in care. LPA observed a fireplace that is covered by means of a large couch and furniture. The bathroom of the residence is observed to be clean and free of toxins. All sharps in the home are stored in an elevated cabinet in the kitchen. Medication in the home are kept in the FCCH bedrooms that are inaccessible to children in care. Additionally, LPA observed all cleaning compounds in the home are stored in the garage that is inaccessible to children in care.

LPA observed a required fire extinguisher (2A10BC) in the home which was service on 10/4/22. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a smoke and carbon monoxide detector which were tested at 11:00 AM and found to be operable.

Applicant informed LPA of the intention to take children in care to neighboring parks in proximity of the residence. LPA reminded Applicant to ensure the children in care are afforded direct supervision while outside of the home and children use play structures and equipment which are age appropriate. Cont 809-C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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: AVALOS FAMILY CHILD CARE
FACILITY NUMBER: 406216433
VISIT DATE: 12/07/2022
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LPA's record review revealed Applicant completed Preventative Health training on 9/22/22 . Further, Applicant completed Mandated Reporter training on 8/18/22 and Pediatric CPR/First Aid (EMSA approved) on 8/23/22. FCCH orientation was completed on 8/9/22. LPA reminded Applicant of obligation to maintain current training and certifications. LPA reviewed Applicant's control of property document (Mortgage Deed). Applicant does have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

LPA reviewed with Applicant the LIC 311D, Forms/Records To Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted.

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 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview and report was reviewed with the Applicant, Ricarda Avalos Calderon in Spanish due to Spanish being Applicant's primary language. The home meets Title 22 Division 12 requirements of a small FCCH license. Effective date of license will be noted as the present, 12/7/22.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022
LIC809 (FAS) - (06/04)
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