566202084-3-7-2023-17-CC-RCHZ-CPPRSV-20230307121724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566202084
Report Date: 03/07/2023
Date Signed: 03/07/2023 12:17:30 PM

Document Has Been Signed on 03/07/2023 12:17 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:	JOHNSON FAMILY CHILD CARE		FACILITY NUMBER:	566202084
ADMINISTRATOR:	JOHNSON, PAULA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 652-1591
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 4	DATE:	03/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Sean Salas		TIME COMPLETED:	12:36 PM

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On March 07, 2023 at 10:29 AM Licensing Program Analyst (LPA) Rona Chavez conducted an unannounced annual inspection. LPA met with licensee Sean Salas and discussed the nature and purpose of the inspection.Together both licensee and LPA conducted a tour of the home inside and outside. There was four (4) children in care at the time of the inspection.

The licensee uses the living room, dining room, kitchen, one restroom, one bedroom and the front yard for the day-care. The back yard is locked with a chain link fence and the backyard was not is not in use for the day care. The back door and the fence are both locked leading to the back yard. There is a spa in the back yard that is covered and has safety locks. Licensee states that there are no firearms and ammunition in the home. LPA did not observe toxins/hazards accessible to children in care. In the living room, LPA observed a fireplace with metal/glass screen in the front preventing children from having access. The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the kitchen with a service date of 09/26/2022. There are age appropriate toys and furniture readily accessible to children. The front yard is fully enclosed with a chain link fence. . Licensee has age appropriate toys and play structures in the front yard in good condition and free of hazards.

A roster of children in care was observed current and complete. A sampling of children's records were reviewed and found complete.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 566202084
	VISIT DATE: 03/07/2023

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Licensee does not have any infants enrolled currently. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 8/2024. Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 2/2025. The last emergency drill was conducted on 2/7/2023 and fire drill on 12/3/2022. All required forms are prominently posted for parent's or authorized representatives in the playroom. Licensee is currently providing Incidental Medical Services (IMS)

Licensee was reminded that all adults 18 and over living or working in the home, 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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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: JOHNSON FAMILY CHILD CARE	FACILITY NUMBER: 566202084
	VISIT DATE: 03/07/2023

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC809 (FAS) - (06/04)

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