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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216619
Report Date: 07/06/2023
Date Signed: 07/06/2023 10:55:45 AM

Document Has Been Signed on 07/06/2023 10:55 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:FLORES FAMILY CHILD CAREFACILITY NUMBER:
406216619
ADMINISTRATOR:CARMEN FLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 286-4209
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/06/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Carmen FloresTIME COMPLETED:
11:10 AM
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On 07/06/23, at 8:55 AM, Licensing Program Analyst (LPA) Dixie Wright conducted an announced Pre-licensing Inspection of the home and met with Applicant Carmen Flores. This application is for a change of location. Applicant stated her operating hours of the Family Child Care Home (FCCH) will be Monday through Saturday, 5:30 AM to 5:30 PM. Applicant intends to care for children zero years of age to thirteen years of age. No children were in care at the time of the inspection.

LPA toured the interior and exterior of the home in its entirety with the applicant. This is a three bedroom, two bathroom single story home. The home's living room, dining room, kitchen, family room (primary day care area) hallway bathroom, bathroom in backyard and the backyard will be used for childcare services. The three hallway bedrooms, laundry room, garage and additional studio living area in the backyard will be excluded. LPA observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has a wood burning stove which is screened and inaccessible. Medications are stored in an elevated cabinet in the kitchen. The Family room to the right of the kitchen is intended to be the primary use for the Day Care. Age appropriate books and toys were observed. Applicant has two pack N plays to care for two infants. The bathroom to be used for children is free of hazards and toxins. Sharps in the home are located in an elevated cabinet in the kitchen. Cleaning compounds are secured in the home's laundry room which is locked and excluded from care.

LPA observed a fire extinguisher (2A10BC) in the home which was serviced on 01/18/2023. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has two smoke detectors. Smoke detector tested at 9:33AM and operable. There is a carbon monoxide detector in the hallway which was tested at 9:36 AM and operable. The backyard is enclosed by wood fencing. The fences entry/exit gates are secured. LPA observed the flooring to be dirt and gravel. There is a pergola for shade. (CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 406216619
VISIT DATE: 07/06/2023
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Age appropriate toys were observed in the backyard. LPA recommended the swing set have rubber mats under the swing set. LPA observed no bodies of water on site. Applicant informed LPA no ammunition or firearms are on the premises.

LPA's record review revealed Applicants' Mandated Reporter training was completed on (expiration 10/24/22), and Pediatric CPR/First Aid (EMSA approved) was completed on 01/13/23 (expiration 01/13/25). LPA reminded Applicant of obligation to maintain current training and certifications.

The Applicant provided proof of control of property.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.
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. Entrance Checklist was provided to the applicant. 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-andresources/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. Megan’s Law - Family Child Care Homes On this date, 07/06/2023, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.
(CONT. LIC 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 406216619
VISIT DATE: 07/06/2023
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Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

A notice of site visit was given to Applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the Applicant Carmen Flores. 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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

The facility did not meet the requirements to be licensed; Facility will be licensed once the following is received:

-Individual living in separate studio living area in backyard must have exemption approval for fingerprint clearance before being licensed. Individual is currently going through the exemption approval process.

-Rubber mats will be installed under swing set in backyard.

-All garden tools will be locked up in backyard shed.

Notice of site visit and appeal rights given to Applicant Carmen Flores.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC809 (FAS) - (06/04)
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