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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426216485
Report Date: 12/28/2022
Date Signed: 12/28/2022 10:17:41 AM

Document Has Been Signed on 12/28/2022 10:17 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:MEJIA FAMILY CHILD CAREFACILITY NUMBER:
426216485
ADMINISTRATOR:FELICIA MEJIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 757-3923
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/28/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Felicia MejiaTIME COMPLETED:
10:24 AM
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On December 28th 2022 at 9:14AM, Licensing Program Analyst (LPA) Rosie Breault conducted an announced inspection for the purpose of performing a change of location. LPA asked licensee pre-screening questions related to COVID-19. Licensee responsed suggest no COVID-19 exposure on site.

LPA met with licensee Felicia Mejia and discussed the purpose of the inspection. Licensee currently holds a large family childcare home (FCCH) license and requested licensure at a new location. LPA and licensee together toured the interior and exterior of the home. Licensee and her husband, and two sons aged 17 and 25 are residing in the home. Husband and elder son are fingerprint cleared. Per licensee, the operating hours will be Monday through Friday from 7:00AM-5:30PM.

All areas identified on the facility sketch were inspected. This is a single story home which consists of three (3) bedrooms, two (2) restrooms, one (1) living room, kitchen, dining room, indoor play area, garage, and outdoor play 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.

Fire clearance was granted on 12/13/2022 and per County Fire Marshall the home is approved for day-care use with following condition: No outside kitchen or laundry room is approved. Garage is NOT to be used for day-care. Fire Marshall noted all unpermitted work in backyard patio has been corrected by a licensed contractor, equating all removed and not to be re-installed without approved plans and building permit.

CONTINUED ON LIC809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Maryrose Breault
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2022
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: MEJIA FAMILY CHILD CARE
FACILITY NUMBER: 426216485
VISIT DATE: 12/28/2022
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Off limit areas included: living room, all three bedrooms, one bathroom, kitchen, garage. Laundry room was removed per request of Fire Marshall. Off limit areas have been secured by locks and gates.

Licensee stated that children will have access to: Indoor play area, one bathroom, outdoor play area and side yard for check in and out purposes.

There are age appropriate toys and furniture on the premises. Knives and medication for the family are stored out children’s reach, inaccessible to children in an elevated cabinet and locked. The outdoor area is completely fenced with locks securing and no bodies of water present. LPA notes there is ample shade for children.

The required fire extinguisher 2A10BC was serviced June 8th, 2022. Smoke detector and carbon monoxide detectors were tested at 9:35AM on 12/28/2022 and were functioning at the time of the insection. Per licensee, stated there are no guns and ammunition in the home. First Aid and emergency kits are available.

Licensee 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.

The home meets Title 22 Division 12 requirements of a large FCCH license. Effective date of Change of Location will be noted as 12/28/2022.

**Due to error on application, the street "Z" was inputted as "2". Please note, new address is 509 N. "Z" St. Lompoc CA 93536, and will be reflected on new approved license.

Exit interview was conducted with licensee and copy of report provided.

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

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC809 (FAS) - (06/04)
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