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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406217020
Report Date: 06/03/2024
Date Signed: 06/03/2024 06:06:04 PM

Document Has Been Signed on 06/03/2024 06:06 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:LOMELI FCC AKA CHUBBY BUNNY DAYCAREFACILITY NUMBER:
406217020
ADMINISTRATOR/
DIRECTOR:
LOMELI, SAMANTHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 400-9855
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/03/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:06 PM
MET WITH:Samantha LomeliTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
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This is a change of location; previous License no. was. 406216020.

On 6/3/2024 at 5:06 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection at the above home. LPA met with the applicant, Samantha Lomeli. LPA discussed the purpose of the inspection. Family Child Care Home (FCCH) will operate from Monday to Friday, from 6:00 AM to 6:00 PM. The FCCH will serve children from 6 months up to 12 years of age.

Applicant and LPA toured the home, it is a one story dwelling, consisting of 3 bedrooms, 2 baths, living room, dining and kitchen areas, fenced backyard, and garage. All the areas in the home were inspected. Areas accessible to children will be the living room, one bedroom converted into play area, dining, kitchen areas, bathroom, and backyard. The backyard has pebbles and dirt surfaces. Inaccessible areas are the two bedrooms and the garage in which chain locks are installed on top of the doors. LPA observed cots, playpen, age-appropriate toys, books, and equipment for children in the playroom.

It was noted that knives and cleaning materials are kept inaccessible to children in care. The bathroom for children’s use is free of toxins during the time of the inspection,

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406217020
VISIT DATE: 06/03/2024
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The 2A10 BC fire extinguisher was serviced on 5/15/2024. Dual carbon monoxide and smoke detectors were tested and found to be functional. The applicant stated that there are no guns and ammunition in the home. Nobodies of water were observed. Applicant provided the proof of control of property.

Applicant completed the FCCH orientation on 11/27/2018, preventative health and nutrition was completed on 3/7/2020. She also completed Pediatric 1st Aid/CPR training on 5/16/2023 (expires on 5/16/2025), while the Mandated Reporter Training was completed on 5/12/2024 (expires on 5/12/2026) Applicant was reminded that it is her responsibility to renew the required training.

LPA discussed the requirement for care providers/employees, including volunteers, to obtain immunization against Influenza, Pertussis, Measles, including verification of Tuberculosis (TB) test.

Prohibited items and equipment in the FCCH, such as walkers, bouncers, etc., were also reviewed with the applicant, as well as 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. Children's record-keeping requirements were also reviewed.

Continued on LIC 809C

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406217020
VISIT DATE: 06/03/2024
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Applicant is not principal is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. 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 discussed the safe sleep regulations with applicant, and discussed the Child Care Licensing Safe Sleep webpage at: htttps://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.



On this date, 6/3/2024, 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; therefore, they may not have been included in this search.


Continued LIC 809C.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406217020
VISIT DATE: 06/03/2024
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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 childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

Fire safety clearance was granted on 5/22/2024

The applicant/home meets the requirements of Title 22 Division 12 for a large Family Child Care Home License. License is effective today, 6/3/2024

Exit interview conducted and report was reviewed with applicant, Samantha Lomeli, Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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