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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215146
Report Date: 12/07/2023
Date Signed: 12/07/2023 06:37:52 PM

Document Has Been Signed on 12/07/2023 06:37 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: 0DATE:
12/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Alicia AcostaTIME COMPLETED:
07:00 PM
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On 12/7/23, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Case Management inspection of the Family Child Care Home (FCCH) for a change of capacity. LPA met with Alicia Acosta, Licensee of the FCCH and explained the nature/purpose of the inspection. LPA notes there were no children present during this inspection.

During this inspection, LPA and Licensee together toured the and interior and exterior of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins at the time of the visit. LPA observed cleaning compounds located in the laundry room and garage. Sharps and medication were observed in elevated cabinet in the kitchen that are inaccessible to children in care. LPA observed a gate making the second floor inaccessible.

LPA reviewed the Licensee’s First Aid/ CPR certification which was completed on 03/23/23. LPA observed a regulation fire extinguisher which was service on 10/12/23. LPA reviewed the Licensee’s Mandated Reporter Training certificate, which was completed on 4/5/23. LPA observed a combination smoke and carbon monoxide detector that was tested at 6:30 PM and was operable.

The Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Ventura County Fire Department granted a fire clearance following an inspection completed at FCCH on 11/29/23.

The home meets Title 22 of CCR requirements for a Large Family Child Care license effective today. Effective date of license is today 12/7/23. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.

Exit interview and review of this report was conducted with licensee, Alicia Acosta in Spanish.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Francisca Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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