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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215698
Report Date: 06/16/2021
Date Signed: 06/16/2021 01:15:37 PM

Document Has Been Signed on 06/16/2021 01:15 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:MASTER FCC AKA FANNIE'S DAY CAREFACILITY NUMBER:
566215698
ADMINISTRATOR:FANNIE VALENZUELA MASTERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 807-6944
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Fannie MastersTIME COMPLETED:
01:25 PM
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On June 16,2021 at 12:05 PM Licensing Program Analysts (LPAs) Austin Rios and Francisco Pedroza conducted an unannounced annual inspection. LPAs met with licensee Fannie Masters and discussed the nature and purpose of the inspection. Together both licensee and LPAs conducted a tour of the home inside and outside. There was 10 children in care at the time of the inspection.

The licensee uses the family room, kitchen, one bedroom, one restroom, and backyard for the day-care. LPAs observed a lock on all bedroom doors making it inaccessible to children in care. There are no bodies of water in the home. Licensee states that there are no firearms and ammunition in the home. LPAs did not observe toxins/hazards accessible to children in care. In the family room, LPAs observed a fireplace with a book case in front of it preventing children from having access. There are age appropriate toys and furniture readily accessible to children. The backyard is fully enclosed with a fenced wall. Licensee has age appropriate toys and play structures in the backyard in good condition and free of hazards. LPA observed there was ample amount of shade available for children.

The home has a working smoke and carbon monoxide detector. A 2A10BC fire extinguisher was observed in the kitchen with a service date of 9-4-2020. Licensee has a valid Pediatric CPR/First Aid certificate with an expiration date of 2/13/2022 Licensee has AB 1207 Mandated Reporter Training Certificate on file expiring on 2/25/2023. The last fire drill was conducted on 1/29/2021. All required forms are prominently posted for parent's or authorized representatives to view at the entrance of the facility.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2021
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: MASTER FCC AKA FANNIE'S DAY CARE
FACILITY NUMBER: 566215698
VISIT DATE: 06/16/2021
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A roster of children in care was observed current and complete. Children's records were reviewed and LPAs observed Identification and Emergency Notification forms (LIC 700) and a copy of immunization records on file as well as parents rights.

LPAs spoke with licensee regarding safe sleep regulations and observed current safe sleep requirements are being met.

Incidental Medical Services (IMS) was discussed. Licensee states currently no children with IMS. 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

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
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