426216698-9-6-2023-17-CC-EBAY-CVEVHS-20230906162738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216698
Report Date: 09/06/2023
Date Signed: 09/06/2023 04:28:24 PM

Document Has Been Signed on 09/06/2023 04:28 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:	DEJESUS DEONILDE FCC AKA CUIDADO DE MIS CORAZONES		FACILITY NUMBER:	426216698
ADMINISTRATOR:	ERICA DEJESUS DEONILDE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 245-7932
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 0	DATE:	09/06/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Erica De Jesus Deonilde		TIME COMPLETED:	03:24 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 8/23/23, at 2:30 PM, Licensing Program Analyst (LPA) Elvin Baddley and German Negrete conducted an announced Prelicense Inspection of the abovementioned home and met with Applicant Erica De Jesus Deonilde. LPAs informed Applicant of the nature and purpose of the inspection. Applicant informed LPAs of the intention to maintain operating hours of a Family Child Care Home (FCCH) from 5:00 AM- 5:30 PM, Monday- Saturday. Applicant also intends to care for children 0 years of age to 12 years of age. Applicant was informed changes in licensing hours or the ages of children supervised and cared for can be altered upon notifying CCLD of the modification or change. LPAs notes, no children are in care at the time of the inspection. LPAs, in the company of Applicant, toured the interior and exterior of the home in its entirety. The home is a single story three bedroom and two bathroom dwelling. The home's living room, hallway restroom and backyard will be used for child care services, while the remainder of the home is excluded. LPAs observed a child safety gate at the entry of the kitchen area. LPAs observed a fire extinguisher in the home which was purchased on 7/25/23. LPAs reminded Applicant of the responsibility to service or purchase a regulation fire extinguisher annually. The home has a number of combination smoke/ carbon monoxide detectors. A combination smoke/carbon monoxide detector in the hallway was tested at 2:44 PM and found to be operable. LPAs observed the home to be clean and orderly. The home has spacing and ventilation for children in care. The home has a fireplace which is screened and secured by glass. The bathroom to be used by children in care is observed to be clean and free of toxins. Medication is observed in an excluded bedroom which is inaccessible to children in care. Sharps are stored in a secure cabinet in the kitchen, while cleaning compounds are stored in the laundry room which is excluded from care. The backyard is enclosed by a combination of wood and cinder block fencing. The footing in the area is (CONT. 809-C, Page 2)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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: DEJESUS DEONILDE FCC AKA CUIDADO DE MIS CORAZONES	FACILITY NUMBER: 426216698
	VISIT DATE: 09/06/2023

NARRATIVE

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varied, The entry/exit gate to the backyard is secure. The backyard has two secure sheds which contain household items and tools. LPAs observed a gate in the side of the backyard which separates the backyard into an area which is used for children services and personal use. Applicant is reminded to provide direct supervision of children when children are involved in outdoor activities away from the home. LPAs observed no bodies of water on site.

LPAs' record review revealed Applicant's Mandated Reporter training was completed on 6/21/23 (expiration 6/21/25), and Pediatric CPR/First Aid (EMSA approved) was completed on 6/23/23 (expiration 6/23/25). Applicant completed Preventative Health Training on 8/22/23. LPAs reminded Applicant of obligation to maintain current training and certifications. Because the Applicant rents/leases the home, proof of landlord notification is required. The LPAs 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. LPAs provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282). Applicant informed LPAs no ammunition or firearms are on site.

LPAs 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.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes 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.

LPAs 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. LPAs 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 of infant devices or their purchased equipment.
(CONT. 809-C, Page 3)

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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: DEJESUS DEONILDE FCC AKA CUIDADO DE MIS CORAZONES	FACILITY NUMBER: 426216698
	VISIT DATE: 09/06/2023

NARRATIVE

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On this date, 9/6/23, 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 address. 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 is 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.

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 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.

Exit interview conducted and report was reviewed with the Applicant Erica De Jesus Deonilde. The home received a fire clearance from the Santa Maria Fire Department for a capacity of 14. As such, the home meets Title 22 Division 12 requirements of a FCCH Large License. Effective date of license will be noted as the present, 9/6/23.

SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Elvin Baddley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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