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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216252
Report Date: 03/08/2022
Date Signed: 03/08/2022 01:12:38 PM

Document Has Been Signed on 03/08/2022 01:12 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:ELIZONDO FCC AKA ELIZONDO FAMILY DAYCAREFACILITY NUMBER:
426216252
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Veronica ElizondoTIME COMPLETED:
01:20 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 03/08/2022 at 10:15AM, Licensing Program Analyst (LPA) S. Mendoza-Ceja met with Veronica Elizondo for the purpose of conducting a pre-licensing inspection. Entrance Checklist was provided to the applicant. The entire home was toured inside and outside. This home has three bedrooms, living room, kitchen, two bathrooms, front yard and backyard. Ms. Elizondo stated the designated child care areas are the kitchen, dinning area, hallway restroom, and primary day care room and enclosed patio area, and the front yard. Ms. Elizondo stated parents will have an option to escort their children to the day care through the front door or back door. LPA observed a gate securing the living room and a sliding door lock making the backyard inaccessible as a play area for day care children, the areas would only be used as entry/walkways to the designated day care areas of the home. LPA observed two locked storage areas in the backyard which are inaccessible to day care children. Ms. Elizondo stated there are no bodies of water, no firearms, nor ammunition in the home. LPA did not observe any bodies of water on the premises. The off limit areas of the home are the three bedrooms/and master restroom which were are secured with plastic door knob covers.

There is a 2 A10 BC Fire Extinguisher (receipt dated 02/13/2022) in the home. Applicant is reminded to service or purchase the fire extinguisher yearly. There is a carbon monoxide and smoke detector which were tested and found to be functional. Ms. Elizondo completed Preventative Health and Safety, including Pediatric 1st Aid/CPR certificate (expires 10/13/2022). The control of property was reviewed and in file. LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, Measles, including verification of TB. Verification is on file for applicant. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or sign a statement declining the influenza vaccine. Ms. Elizondo completed the Child Abuse Mandated Reporter Training on 09/08/2020 (expires 09/08/2022) and is required to be completed every two years. LPA discussed COVID-19.
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. LPA provided the sample forms for applicant.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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 2
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: ELIZONDO FCC AKA ELIZONDO FAMILY DAYCARE
FACILITY NUMBER: 426216252
VISIT DATE: 03/08/2022
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 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-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.

Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.

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: http://www.ada.gov/childqanda.htm



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 platform.
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.

Licensure effective 03/08/2022.

Exit interview conducted and report was reviewed with the applicant Veronica Elizondo.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Sylvia Mendoza-Ceja
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2