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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215146
Report Date: 07/28/2022
Date Signed: 07/28/2022 03:36:41 PM

Document Has Been Signed on 07/28/2022 03:36 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:ACOSTA FAMILY CHILD CAREFACILITY NUMBER:
566215146
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Alicia AcostaTIME COMPLETED:
12:02 PM
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On July 28, 2022 at 9:50 AM Licensing Program Analysts Laura Villanueva and Susana Martinez conducted an unannounced required 1-year inspection. LPA's met with licensee Alicia Acosta and advised her of the purpose for the inspection. Prior to entering the facility LPA's conducted COVID-19 screening questions, all answers indicated the facility to be COVID free. At the time of the inspection there were four (4) children in care. LPA's and licensee toured the home together inside and out. The home is a two story home with four (4) bedrooms and three (3) bathrooms, and a patio. The licensee uses the living-room, one (1) bedroom downstairs, one (1) bathroom downstairs, patio and kitchen for the day-care. LPA's observed the stairs to have a barricade preventing children from accessing the second floor.

LPA's observed the home to be free of hazards/toxins. The licensee has age-appropriate toys, learning materials and play structures inside and outside the home. Fire place in the living-room is screened making it inaccessible to the children. LPA's observed a dual carbon monoxide and smoke detector mounted in the kitchen wall. LPA's also observed a regulatory 2A10BC fire extinguisher that was last serviced on 11/10/2021. Licensee was reminded to service or purchase a fire extinguisher every year. Licensee provided proof of fire and earthquake drills which were last conducted on 7/22/2022. LPA's observed all cleaning supplies stored in a cabinet located in the laundry room which is inaccessible to children in care. Licensee keeps knives and medication in a top kitchen cabinet which is out of reach for children in care. LPA's observed locks on lower kitchen cabinets.

A sampling of children's records were reviewed to be complete and current. Licensee's First Aid/CPR certificate is current with expiration date of 3/5/2024. Licensee's Mandated Reporter Training Certificate is also current with an expiration date of 6/1/2024. All required documents to be posted were observed at the entrance of the facility mounted on the wall.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
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: ACOSTA FAMILY CHILD CARE
FACILITY NUMBER: 566215146
VISIT DATE: 07/28/2022
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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/inspection-process.

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.

Incidental Medical Services (IMS) policy was discussed. Licensee is not caring children requiring IMS at the moment For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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)/ (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

No deficiencies cited during this visit. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed in Spanish with the licensee, Alicia Acosta.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022
LIC809 (FAS) - (06/04)
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