426216579-7-27-2023-17-CC-EBAY-CU5QN4-20230727121832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216579
Report Date: 07/27/2023
Date Signed: 07/27/2023 12:18:39 PM

Document Has Been Signed on 07/27/2023 12:18 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:	PANTOJA-SANCHEZ FCC		FACILITY NUMBER:	426216579
ADMINISTRATOR:	ALONDRA PANTOJA-SANCHEZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 332-9136
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	07/27/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alondra Pantoja-Sanchez		TIME COMPLETED:	12:30 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 7/27/23, at 9:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Alondra Pantoja-Sanchez. LPA informed Applicant of the nature and purpose of the inspection. Applicant informed LPA of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 6:00 AM--5:00 PM, Monday- Friday. Applicant also intends to care for children 0 years of age to 12 years of age. LPA informed Applicant the time of operation as well as the age of the children to be cared for can be modified with notification to CCLD. LPA notes, no children are in care at the time of the inspection. LPA, in the company of Applicant, toured the interior and exterior of the home, in its entirety. The home is a three bedroom room, two bathroom single story dwelling. The home's living room, dining room, kitchen, hallway bathroom, and backyard will be used for child care services, while the the remainder of the home will be excluded. LPA observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has no fireplace. LPA observed the bathroom to be used for children in care to be clean and free of toxins. Sharps and medication in the home are stored in elevated kitchen cabinets, while cleaning compounds are observed in the laundry room which is an area excluded from care. LPA observed a fire extinguisher (2A10BC) in the home which was purchased on 3/13/23. LPA reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has operable combination smoke/carbon monoxide detectors, one of which were tested at 10:50 AM. The backyard is enclosed by cinder block and the footing in the area is varied. The outdoor activity area is covered by a roof. The backyard's entry/exit gates are secured. There are two child safety gates in backyard which separated areas of child care from area of personal. The is also a storage shed in the backyard area (CONT. LIC 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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: PANTOJA-SANCHEZ FCC	FACILITY NUMBER: 426216579
	VISIT DATE: 07/27/2023

NARRATIVE

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which contains household items. In an excluded are if the backyard is a Accessory Dwelling Unit (ADU). A tenant (Ausencia Lara Herandez) of the home reside in the ADU. Applicant was informed the tenant of the ADU must be criminal cleared and associated to the prospective Family Child Care Home. LPA notes the tenant of the home's ADU is not criminal cleared and associated with the home at this time. LPA also notes three dogs are on site. Vaccination records for the dogs were reviewed and are current. LPA observed no bodies of water on site.

LPA's record review revealed Applicants' Mandated Reporter training was completed on 11/15/22 (expiration 11/15/24), and Pediatric CPR/First Aid training (EMSA approved) was completed on 11/17/22 (expiration 11/17/24). Applicant completed Preventative Health Training on 11/17/22. LPA reminded Applicant of obligation to maintain current training and certifications.

Because the Applicant leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC 9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149). Applicant does not have liability insurance for the home as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant informed LPA no ammunition or firearms are on site.

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. Entrance Checklist was provided to the applicant.

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) or (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.

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, 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
(CONT. LIC 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

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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: PANTOJA-SANCHEZ FCC	FACILITY NUMBER: 426216579
	VISIT DATE: 07/27/2023

NARRATIVE

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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 Applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/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.

On 7/27/23, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, 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.

Exit interview conducted and report was reviewed with the Applicant Alondra Pantoja-Sanchez. Licensure is pending criminal cleared and associated of tenant Ausencia Lara Hernandez to the home.

Community 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 platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC809 (FAS) - (06/04)

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