426216999-5-29-2024-17-CC-GGOZ-D5QQF2-20240529120713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426216999
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:07:34 PM

Document Has Been Signed on 05/29/2024 12:07 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	VALENCIA FAMILY CHILD CARE		FACILITY NUMBER:	426216999
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 1	DATE:	05/29/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:40 AM
MET WITH:	Dennys Valencia		TIME VISIT/ INSPECTION COMPLETED:	12:21 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 May 29, 2024. Licensing Program Analysts (LPAs) Giovani Gonzalez and Julia Meli conducted an announced Prelicensing inspection at the above-mentioned residence. LPAs met with applicant Dennys Valencia and informed them the purpose of the inspection. At the time of the inspection the applicant's own daughter was present. Applicant informed LPAs the intention to serve children ages 0-12 years of age and have operating hours of 6AM - 4PM, Monday to Friday. LPAs in the company of the applicant toured the interior and exterior of the home in its entirety. The home is a single story house that consists of 2 bedrooms, 1 bathroom, kitchen, living room and backyard. The home's living room, 1 bathroom and backyard will be used for child care purposes, while the remainder of the home will be excluded from care. LPAs observed the home to be clean and orderly. The home has sufficient spacing and ventilation for children in care. LPAs observed the living room to have children's furniture and equipment. LPAs observed the kitchen to be made inaccessible to children in care with a child gate. LPAs observed the cabinets and drawers to be secures with child proof locks. LPAs observed sharps to be stored in an elevated cabinet in the kitchen that is also secured with a child proof lock. LPAs observed cleaning compounds to be stored in an elevated cabinet in the kitchen as well. LPAs observed the rooms to be made inaccessible to with child proof locks and have the ability to be locked as well. LPAs reminded applicant that in order for the areas to be inaccessible, the areas must be secured when children are present. LPAs observed the bathroom to be used for children to be clean and free of toxins. LPAs observed the backyard to be completely enclosed with a fence. LPAs observed that the applicant only intends to use 1 half of the yard for children in care, and that the other half is fenced off and secured. LPAs observed the exit ways to be secured and have the ability to be locked. LPAs observed plenty of space for children's activities and that children's side of the yard to be free of hazards. CONTINUED PAGE 2

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VALENCIA FAMILY CHILD CARE	FACILITY NUMBER: 426216999
	VISIT DATE: 05/29/2024

NARRATIVE

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LPAs observed a fire extinguisher (3A40BC) that satisfies regulation, which was purchased 5/29/24. LPAs reminded applicant that they must service or purchase a regulation fire extinguisher annually. The home has a smoke detector and a carbon monoxide detector which were tested at 10:03AM Applicant stated there are no firearms in the home.

LPAs' record review revealed Preventative Health training was completed on 3/8/2024 . Further, Applicant completed Mandated Reporter training on 2/28/2024 and Pediatric CPR/First Aid (EMSA approved) on 3/9/2024. Applicant completed FCCH orientation on 2/24/2024. LPA reminded Applicant of obligation to maintain current training and certifications. Applicant does not have liability insurance for the license as of yet. LPA provided Applicant with Affidavit Regarding Liability Insurance form (LIC 282).

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 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.

The applicant provided proof of control of property. Because the applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

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.

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.
CONTINUED PAGE 3

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: VALENCIA FAMILY CHILD CARE	FACILITY NUMBER: 426216999
	VISIT DATE: 05/29/2024

NARRATIVE

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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.

On this date, 5/29/2024, 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.

The home meets Title 22 of CCR requirements for a Small Family Child Care license. The effective date of license is noted as the present 5/29/2024.

Exit interview conducted and report was reviewed with the applicant Dennys Valencia. Notice of site visit was given.

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-care-licensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Giovani Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

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