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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216032
Report Date: 12/03/2024
Date Signed: 12/04/2024 08:43:25 AM

Document Has Been Signed on 12/04/2024 08:43 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:CERPAS FCC AKA KID CITY DAYCAREFACILITY NUMBER:
426216032
ADMINISTRATOR/
DIRECTOR:		ANNETTE CERPASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 314-5298
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
12/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Annette Cerpas TIME VISIT/
INSPECTION COMPLETED:
01:10 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 December 3, 2024 Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Required - 3 Year inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with licensee Annette Cerpas and informed them the purpose of the inspection. At the time of the inspection 9 children and 1 assistant were present.

LPA in the company of the of the licensee toured the interior and exterior of the FCCH. LPA observed the living room to be clean an free of hazards. LPA observed a fire place that is secured with a child proof lock. LPA observed the children's play room to have sufficient children's equipment and ventilation for children in care. LPA observed the side door of the play room to have the ability to be locked and reminded licensee the door must be locked in order for the side of the home to be inaccessible to children in care. LPA observed the kitchen to be made inaccessible to children via child proof gates on both sides. Licensee informed LPA sharps and medication are stored in an elevated kitchen cabinet. LPA notes the home's bedrooms are made inaccessible via a child proof gate as well. LPA observed the bathroom used by children to be free of hazards. LPA notes the home's cleaning compounds are stored in the garage.

LPA observed the backyard to be completely enclosed. LPA observed sufficient space for children's activities. LPA observed the backyard to have plenty of children's equipment that is in good condition. LPA reminded licensee when toys are damaged/broken they must be removed. LPA observed an unlocked storage shed that was free of hazards.

The FCCH has a combination smoke and carbon monoxide detector which was tested at 11:01 AM and found in working order. LPA observed the FCCH to have a regulation fire extinguisher which was serviced on 11/28/2022. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually. 1 Type B deficiency is being issued on the attached LIC809D.
CONTINUED PAGE 3
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 7
Document Has Been Signed on 12/04/2024 08:43 AM - It Cannot Be Edited


Created By: Giovani Gonzalez On 12/03/2024 at 11:59 AM
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: CERPAS FCC AKA KID CITY DAYCARE
FACILITY NUMBER: 426216032

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and intervew the licensee did not comply with the section cited above in not having a fire extinguisher serviced since November of 2022, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/10/2024
Plan of Correction
1
2
3
4
Licensee will service or purchase a regulation fire extinguisher no later than 12/10/2024. Licensee will provide proof of complete to LPA via email at giovani.gonzalez@dss.ca.gov.
Type B
Section Cited
CCR
102425(j)(2)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview , the licensee did not comply with the section cited above in 3 out of 3 infants not having documented Safe Sleep checks which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/17/2024
Plan of Correction
1
2
3
4
Licensee will conduct Safe Sleep checks and document them for the following 2 weeks. Licensee will provide proof of complete to LPA via email at giovani.gonzalez@dss.ca.gov.
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:Ana Tolentino
LICENSING EVALUATOR NAME:Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


LIC809 (FAS) - (06/04)
Page: 2 of 7
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: CERPAS FCC AKA KID CITY DAYCARE
FACILITY NUMBER: 426216032
VISIT DATE: 12/03/2024
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 a sampling of children's files. LPA observed 1 of 6 children's files to be missing an immunization record. 1 Technical Violation was issued as a result. LPA asked licensee about Safe Sleep logs and licensee informed LPA they have not been conducting them. 1 Type B deficiency is being issued as a result. LPA reviewed assistants file which was found to be current and complete. LPA observed both Licensee's and assistants Mandated Reporter and CPR/First Aid to be current. LPA reminded licensee it is their responsibility to have current certifications and training.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Incidental Medical Services (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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.
CONTINUED PAGE 3
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: CERPAS FCC AKA KID CITY DAYCARE
FACILITY NUMBER: 426216032
VISIT DATE: 12/03/2024
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
Licensee was informed of the MyChildCarePlan.org website; 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.

During the exit interview, the Licensee, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

2 Type B deficiencies were issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Annette Cerpas . Appeal Rights were given.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
Page: 7 of 7