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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216641
Report Date: 06/29/2023
Date Signed: 06/29/2023 11:01:27 AM

Document Has Been Signed on 06/29/2023 11:01 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:GLOVE FAMILY CHILD CAREFACILITY NUMBER:
406216641
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
06/29/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Dawn GloveTIME COMPLETED:
11:15 AM
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On 06/29/23, at 8:50 AM, Licensing Program Analyst (LPA) Dixie Wright conducted an announced Pre-licensing Inspection of the home and met with Applicant Dawn Glove. Applicant stated her operating hours of the Family Child Care Home (FCCH) will be seven days a week, 24 hours a day. Applicant intends to care for children zero years of age to ten 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, kitchen, back bedroom and bathroom and backyard will be used for child care services. The two hallway bedrooms and hallway bathroom 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 Applicant stated she has never used and does not intend to use, it is more for decor. LPA observed the inside of the wood burning stove and did not observe any wood in the stove. Medications are stored high in a locked closet in the hallway. The back, master bedroom is intended to be the primary use for the Day Care. Age appropriate books and toys were observed. Applicant has one pack n play to care for one infant. The bathroom to be used for children is free of hazards and toxins. Sharps in the home are located on top of the refrigerator 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 06/19/2023. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has numerous smoke detectors and a combination smoke/ carbon monoxide detector in the hallway. The smoke/carbon monoxide detector was tested at 9:32 AM and found to be operable.The backyard is enclosed by wood fencing. The fences entry/exit gates are secured. LPA observed rubber flooring, artificial turf, and wood chips as flooring in the backyard play area. The outdoor patio area is concrete and shaded. Applicant intends to put a 12 X 12 sandbox in the backyard. (CONT. LIC 809-C, Page 2)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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: GLOVE FAMILY CHILD CARE
FACILITY NUMBER: 406216641
VISIT DATE: 06/29/2023
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Age appropriate toys were observed in the backyard. 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 04/10/22 (expiration 04/10/25), and Pediatric CPR/First Aid (EMSA approved) was completed on 4/26/23 (expiration 04/26/25). Applicant completed Preventative Health Training on 04/30/22. LPA reminded Applicant of obligation to maintain current training and certifications.
The applicant has not obtained a signed Property Owner/Landlord Consent form (LIC9149). Without this consent, the applicant understands that, once licensed, they can operate with a maximum capacity of six children. If property owner/landlord consent is obtained in the future, the applicant is advised that a new Application for a Family Child Care Home License (LIC 279) must be submitted with a change of capacity fee of $25, to increase the capacity and provide care to 8 [or 14] children.
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
(CONT. LIC 809-C, Page 3)
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
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: GLOVE FAMILY CHILD CARE
FACILITY NUMBER: 406216641
VISIT DATE: 06/29/2023
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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, 06/27/2023, 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.


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 Dawn Glove. 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.


Effective date of license will be when LPA receives the following:

-North side of yard is showing inaccessible on facility sketch, but is still accessible. Applicant states she is installing a barrier/gate to make the area inaccessible this weekend. Once proof of that is sent to LPA, the license will be issued.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Dixie Marie Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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