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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216366
Report Date: 07/25/2022
Date Signed: 07/25/2022 10:20:19 AM

Document Has Been Signed on 07/25/2022 10:20 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:LARSON FCC AKA STEPPINGSTONE DAYCAREFACILITY NUMBER:
426216366
ADMINISTRATOR:CHEYENNE WILEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 896-6685
CITY:ORCUTTSTATE: CAZIP CODE:
93455
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/25/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cheyenne Larson TIME COMPLETED:
10:20 AM
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This is a change of location, previous License no. was 426215576.
On July 25, 2022 @ 8:40 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an announced pre-licensing inspection. Prior to inspection, LPA asked Applicant Pre- Screening questions related to COVID-19 applicant’s responses to the Pre-screening questions suggest no COVID-19 exposure on site. LPA met with applicant Ms. Cheyenne Larson and discussed the purpose of the inspection. There were no children present during the inspection.

LPA conducted the physical plant tour of the home. During this tour the following was noted: Applicant applied for a Change of Location on June 29, 2022. Family members residing in the home are 2 adults. All adults in the home are fingerprint cleared. Per Applicant, the operating hours will be Monday through Friday from 7 00 a.m. to 5:00 p.m. Applicant states she wants to care for children from 0 month to 13 years of age.

All areas identified on the facility sketch were inspected. This is a 3 story home with a basement composed of 4 bedrooms and 4 baths. Two day care rooms are to be used mainly for day care children which are located in the 1st floor and the basement. Living room, dining room, kitchen and one bathroom will be accessible to day care children. The second floor is off limit with a baby gate in the he stair case making it inaccessible to day care children. Garage is also an off limit area. The home was inspected for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents, cleaning compounds, medicines, and hazardous items that can pose a danger to children. LPA observed the day care play area to be safe with age appropriate toys, games etc. The back yard is enclosed with wooden fence.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Gigi Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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: LARSON FCC AKA STEPPINGSTONE DAYCARE
FACILITY NUMBER: 426216366
VISIT DATE: 07/25/2022
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The required fire extinguisher 2A10BC was purchased on 12/16/2021. Dual Smoke detector, carbon monoxide detectors were tested at 9:00 AM and were functioning at the time of the visit. Per Applicant, there are no guns nor ammunition in the home. First Aid and emergency kits are available. Applicant has Pediatric CPR and First Aid expires on 2/18/2023. Applicant took the Mandated Reporter Training Certificate which expires on 1/10/2024

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

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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


Notice of Site Visit was issued. Exit interview was conducted and report was reviewed with Applicant, Ms. Cheyenne Larson.

The fire safety inspection clearance was granted on July 21. 2022. The home meets Title 22 Division 12 requirements of a Large FCCH, License is effective today, July 25, 2022.

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

DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2022
LIC809 (FAS) - (06/04)
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