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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208395
Report Date: 09/27/2021
Date Signed: 09/28/2021 08:31:33 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/28/2021 08:31 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
426208395
ADMINISTRATOR:ALMA GARCIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 325-3646
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
09/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alma GarciaTIME COMPLETED:
05:30 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
On 9/27/2021, Licensing Program Analyst Gigi Reyes conducted an unannounced Required Annual Inspection, met with Licensee and discussed the purpose of the inspection. Prior to inspection, LPA asked pre health screening questions related to COVID 19, Licensee's responses indicate there are no COVID 19 exposure in the Family Child Care Home (FCCH).

LPA and Licensee toured the interior and exterior of the home, there were 2 children present . During the tour LPA observed the following, appropriate fire extinguisher was serviced on 10/21/2020, Licensee was reminded that it should be serviced every year or purchase a new one. Smoke and carbon monoxide detectors were tested and found functional. Toxins are locked. The backyard is completely fenced. LPA observed that LIC 610 Emergency Disaster Plan was not posted at the time of the inspection. LPA provided the new form to be filled out. LPA observed age appropriate toys and equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

LPA reviewed the following documents, Pediatric CPR and First Aid Card expired on 2/2/2021. Licensee and spouse/assistant have no record of immunization as required by SB 792. Spouse stated he has a full time job and he is not working in the FCCH. Licensee also stated that spouse was there to translate during the inspection. However, upon arrival LPA observed the spouse caring for a child. Licensee had not taken the Mandated Reporter Training per AB 1207. FCCH is not conducting Fire and Disaster drill every 6 months. Last drill was conducted on 10/4/2016.

Continued on LIC 809C
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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 6
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: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 426208395
VISIT DATE: 09/27/2021
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
LPA reviewed children records. Files of Child # 1 and Child # 2 are not maintained at FCCH during the time of inspection. Child 1 and Child 2 have no records for review. LPA provided the packet of forms/records to keep in Family Child Care Home. LPA advised Licensee to provide all the required forms to parents and /or authorized representative of the child. LPA discussed all the licensing forms with the licensee.

LPA discussed Safe Sleep Regulations with Licensee. Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm

Licensee was reminded that it is her responsibility to know the regulations for FCCH which can be accessed on-line at www.ccld.ca.gov.

During the inspection, deficiencies were cited under Title 22 division 12 and Health and Safety Code documented under LIC 809D. Appeal Rights were provided and explained.

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

The inspection and report was translated in Spanish by Licensee's husband, Ernesto Garcia and Licensee's son, Bryan Garcia.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 09/28/2021 08:31 AM - It Cannot Be Edited


Created By: Gigi Reyes On 09/27/2021 at 03:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 426208395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2021
Section Cited
CCR
102416

1
2
3
4
5
6
7
Personnel Requirements
(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirment is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to register and take the Adult and Pediatric CPR no later than 10/14/2021 and submit the proof to CCLD.
gigi.reyes@dss.ca.gov
8
9
10
11
12
13
14
During facility file review, it was observed that Licensee's CPR and First Aid expired on 2/2/2021. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Type B
10/07/2021
Section Cited
CCR102421

1
2
3
4
5
6
7
102421 Child's Records
(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to provide parents the children's record/forms to be filled out and signed. Licensee shall submit proof of correction to CCLD no later than 10/07/2021
8
9
10
11
12
13
14
 LPA review of children's record revealed that Child 1 and Child 2 have no records or file.
This poses a potential risk to health and safety of chil
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/28/2021 08:31 AM - It Cannot Be Edited


Created By: Gigi Reyes On 09/27/2021 at 03:36 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 426208395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2021
Section Cited
CCR
102419

1
2
3
4
5
6
7
102419 Admission Procedures and Parental and Authorized Representative's Rights
(a) The licensee shall inform parents or authorized representatives of children in care of their rights, which include, but are not limited to, the following....
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to provide parents the children's record/forms to be filled out and signed. Licensee shall submit proof of correction to CCLD no later than 10/07/2021.
8
9
10
11
12
13
14
LPA review of children's records revealed that Child 1 and Child 2 do not have files that contain all the signed copies of documents provided to parents upon enrollment of the child into FCCH. This poses a potential risk to health and safety of chidlren in care.
8
9
10
11
12
13
14
Type B
10/07/2021
Section Cited
CCR102418

1
2
3
4
5
6
7
102418 Immunizations
a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to obtain copy of Child 1 and Child 2's immunization record and document it on blue immunization card , CDPH/PM 286. Licensee shall submit proof of correction to CCLD no later than 10/7/2021.
8
9
10
11
12
13
14
LPA review of children's records revealed that Child 1 and Child 2 were accepted to FCCH without the record of immunization. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 09/28/2021 08:31 AM - It Cannot Be Edited


Created By: Gigi Reyes On 09/27/2021 at 03:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 426208395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2021
Section Cited
HSC
1596.8662(4)(b)(1)

1
2
3
4
5
6
7
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training... and shall complete renewal every two years ...
This requirement is not met as evidenced by
1
2
3
4
5
6
7
Licensee agreed to take AB 1207 Mandated Reporter and submit the proof no later than 10/07/2021.

mandatedrporterca.com
8
9
10
11
12
13
14
During facility file review, it was observed that Licensee nor the assistan/spouse have no Mnadated Reporter Training.
This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Type B
10/07/2021
Section Cited
CCR102425(j)(2)(D)

1
2
3
4
5
6
7
j) The provider shall supervise infants while they are sleeping and adhere to the following requirements:
(1) The provider shall physically check on the infant every 15 minutes...
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to check and document the sleeping infant every 15 minutes. Plan of Correction shall be submitted no later than 10/4/2021
8
9
10
11
12
13
14
LPA review of child's records revealed that licensee is not documenting the every 15 minute supervision of sleeping infants - Child 1 and Child 2. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 09/28/2021 08:31 AM - It Cannot Be Edited


Created By: Gigi Reyes On 09/27/2021 at 04:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 426208395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/07/2021
Section Cited
CCR
102417(9)(a)(1)

1
2
3
4
5
6
7
102417(9)(a)(1)
Each family child care home shall conduct fire drills and disaster drills at least once every six months.
1. The licensee shall document the drills, including the date and time of each drill... This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to conduct and document fire and disaster drill on 10/08/2021 and submit proof of correction to CCLD no later than 10/7/2021.
gigi.reyes@dss.ca.gov
8
9
10
11
12
13
14
LPA review of facility record revealed that FCCH is not conducting fire and disaster drill every 6 months as required. Last drill was conducted on 10/4/2016. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Type B
09/27/2021
Section Cited
CCR102417(g)(9)

1
2
3
4
5
6
7
102417(g)(9) Operation of a Family Child Care Home. Each home shall have a written disaster plan prepared on a form approved by the Department. Everyone in the home, age and ability permitted, shall be instructed of their duties under the disaster plan.


1
2
3
4
5
6
7
Licensee agreed to complete form LIC 610A and post it in the prominent location and submit paln of correction to CCLD no later than 10/07/2021.
8
9
10
11
12
13
14
During inspection, LPA observed that there was no LIC 610 Emergencydisaster Plan posted in FCCH. This poses a potential risk to health and safety of children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maria Mueller
LICENSING EVALUATOR NAME:Gigi Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2021


LIC809 (FAS) - (06/04)
Page: 6 of 6