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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216035
Report Date: 01/23/2023
Date Signed: 01/23/2023 11:42:24 AM

Document Has Been Signed on 01/23/2023 11:42 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:ESPINOSA FAMILY CHILD CAREFACILITY NUMBER:
426216035
ADMINISTRATOR:JOSEFINA N ESPINOSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 698-7183
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Josephina EspinosaTIME COMPLETED:
11:50 AM
NARRATIVE
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On January 23rd, 2023, at 8:45AM, Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with licensee Josephina Espinosa and advised her the purpose of the inspection. In the home during the inspection was licensee stepson and husband both fingerprint cleared. Licensee provided LPA a tour of the home inside and out. There were six (6) children present at the time of the inspection with husband (assistant).

Children enter through the side gate of Family Child Care Home (FCCH), LPA observed required postings in a prominent location, and FCCH used written sign in and out logs. The licensee is currently using one playroom with attached bathroom, living room for napping, and outdoor play area. In the playroom, LPA observed appropriate toys and furnishings, bathroom to be clean and free of toxins, poisons, hazards, or combustibles. Licensee utilizes a changing table for children and children’s supplies are kept separate. LPA observed a 2A10BC fire extinguisher with a purchase date of 4/10/2022. Licensee reminded to service or purchase fire extinguisher every year.

Licensee indicated she has not been conducting and documenting emergency drills. This is a violation of Title 22 Division 12 102417 (a) and a Type B violation will be cited. LPA provided copy of Emergency Fire Drill Log for assistance. Napping room contained cribs and cots for children in care. Licensee stated she has not been keeping sleep logs for infants. This is a violation of Title 22 Division 12 102425 (d) and a Type B violation will be cited. LPA reminded licensee of Safe Sleep procedures and LPA provided Safe Sleep FAQs for reference.


CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 426216035
VISIT DATE: 01/23/2023
NARRATIVE
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LPA observed a fireplace that was screened off and inaccessible to children. The smoke and carbon monoxide detectors were tested at 9:19AM and were functioning at the time of the inspection. Backyard play area has perimeter fencing and gates with age-appropriate play structures and toys for children in care. Children bring their own water bottles and filtered water is available for children. There are no bodies of water present and licensee stated no firearms or ammunition are present in the home.

No Incidental Medical Services are being provided at this time.

LPA observed the facility roster was current. A sampling of children records was reviewed and found to be current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee's Pediatric CPR/First-Aid certificate is current and valid until 3/2023. Licensee's Mandated Reporter certificate is not present or current. Licensee stated she or her assistant have not completed the Mandated Reporter Training since the first time it was completed (FCCH licensed on 1/11/2021). LPA reminded licensee Mandated Reporter Training shall be renewed every two years. This is violation of Health and Safety Code (HSC) 1596.8662(b)(1) and a Type B violation will be cited.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. 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: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
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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: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 426216035
VISIT DATE: 01/23/2023
NARRATIVE
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Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] 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 [facility representative] 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.

Citations are attached on corresponding LIC809D

Exit interview conducted, reviewed, and copy provided to licensee with appeal rights.

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.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2023
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Document Has Been Signed on 01/23/2023 11:42 AM - It Cannot Be Edited


Created By: Maryrose Breault On 01/23/2023 at 10:47 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: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 426216035

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(a)
Each FCCH shall conduct fire drills and disaster drills every six months...licensee shall document drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on licensee's statement, the licensee did not comply with the section cited above in one count which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/01/2023
Plan of Correction
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Licensee to conduct a disaster/fire drill by 2/1/2023 and provide document to LPA via email: maryrose.breault@dss.ca.gov
Type B
Section Cited
CCR
102425(j)(1)
The provider shall physically check on the infant every 15 minutes... and document the following...

This requirement is not met as evidenced by:
Licensee stated she has not been documenting children's napping.
Deficient Practice Statement
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Based on licensee statement and record review, the licensee did not comply with the section cited above in one coune count out of two counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/01/2023
Plan of Correction
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Licensee to provide current napping logs commenceing 1/24/2023 - 2/1/2023 to LPA via email: maryrose.breault@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:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/23/2023 11:42 AM - It Cannot Be Edited


Created By: Maryrose Breault On 01/23/2023 at 10:58 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: ESPINOSA FAMILY CHILD CARE
FACILITY NUMBER: 426216035

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.866(b)(1)
Child care provider shall complete the Mandated Reporter Training...every two years.

Deficient Practice Statement
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Based on licensee's statement and record review, the licensee did not comply with the section cited above in 2 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/01/2023
Plan of Correction
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Licensee and assistant(s) shall complete Mandated Reporter Training and provide copy of certificate to LPA via email: maryrose.breault@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Maryrose Breault
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023


LIC809 (FAS) - (06/04)
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