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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215698
Report Date: 06/01/2022
Date Signed: 06/01/2022 03:10:26 PM

Document Has Been Signed on 06/01/2022 03:10 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: 14CENSUS: 9DATE:
06/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Fannie ValenzuelaTIME COMPLETED:
03:35 PM
NARRATIVE
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On June 01, 2022 at 11:33 AM, Licensing Program Analyst Dean Thompson conducted an unannounced Annual/Random inspection. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with licensee Fannie Valenzuela and advised the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were nine (9) children and one (1) adult (Licensee) present at the time of the inspection.

When LPA arrived, LPA observed a parent (P1) entering the facility. When LPA entered the facility, licensee and P1 were communicating (whispering). LPA observed licensee was not in compliance with staff and capacity ratio. Licensee had nine (9) children in care, four (4) of the children were infants. LPA observed P1 leaving the facility with her own child and two other children C1 and C2 from the day care. C1 and C2 were given to P1 by licensee. Licensee advised LPA, P1 was the parent of C1 and C2.

LPA reviewed the roster, children files, and it was determined P1 was not the parent of C1 or C2. LPA also reviewed C1 and C2 identification and emergency information form. It was determined P1 was not authorize to take the children C1 and C2 from the facility. It was determined by LPA, licensee allowed C1 and C2 to be taken by P1 so that she was in compliance with staff and capacity ratio. LPA had licensee call P1 to return C1 and C2 back to the Family Day Care. C1 and C2 were taken away from the facility for approximately 30 minutes.

LPA observed required licensing documents mounted on the wall near the entrance of the home. Fire and earthquake drills are being documented every six months. Last drill was conducted on 1/28/2022. Fire extinguisher 2A10BC was last serviced 9/14/2021. Fire and carbon monoxide detectors were tested and working.

Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 06/01/2022
NARRATIVE
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Children in care have access to living room, one restroom, kitchen, and back yard. Kitchen cabinets were locked and knives are being kept in a cabinet above counters to keep out of reach from children. Children have access to toys that are age-appropriate inside and outside of the home. Back yard play area is enclosed and has plenty of bicycles, scooters, and activities. Licensee stated there are no firearms or ammunition on the property. There are no bodies of water present at the time of inspection. During the tour, LPA did not observe any hazards/toxins items accessible to children in care.

LPA reviewed nine (9) out of nine (9) children files. All children files were current. Licensee CPR/first aid is valid through 1/2024 and mandated reporter certification is current.

Licensee advised there were no children in care that required Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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

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.


Continued on 809-C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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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: 06/01/2022
NARRATIVE
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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. LPA observed a safe sleep log being documented for infants in care every 15 minutes.

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 Thompson informed licensee Fannie Valenzuela that this report dated 6/1/2022 document(s) Three Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed the licensee Fannie Valenzuela to provide a copy of this licensing report dated 6/1/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Three Type A deficiencies were cited during today's inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with the licensee Fannie Valenzuela.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2022
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Document Has Been Signed on 06/01/2022 03:10 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/01/2022 at 02:09 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MASTER FCC AKA FANNIE'S DAY CARE
FACILITY NUMBER: 566215698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA observed licensee give two children (C1)(C2) from care to an unathorized parent (P1) that was not fingerprint cleared or associated to the facility to help provide with care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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LPA observed Parent P1 bring children C1 and C2 back to the facility.

An Informal Conference meeting will be scheduled at a later date by 6/15/2022.
Type A
Section Cited
CCR
102416.5(e)
Staffing Ratio and Capacity
(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above. LPA observed licensee providing care alone and was not in compliance with staff and capacity ratio. Licensee had nine (9) children in care, four (4) of the children were infants which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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Parents were being called and informed they needed to pickup their children in care so that licensee was back in compliance with staff and capacity ratio. Licensee called her husband to return home so that she was able to be in compliance.
An Informal Conference meeting will be scheduled at a later date by 6/15/2022.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022


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Document Has Been Signed on 06/01/2022 03:10 PM - It Cannot Be Edited


Created By: Dean Thompson On 06/01/2022 at 02:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: MASTER FCC AKA FANNIE'S DAY CARE
FACILITY NUMBER: 566215698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102402(a)(3)
102402 Revocation or Suspension of a License or Registration.

(a) The Department shall have the authority to suspend or revoke any license for the following reasons: (3) Conduct in the operation or maintenance of a family day care home which is inimical to the health, morals, welfare, or safety of either an individual in or receivingservices from the facilityor the people of the State of California.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA observed licensee give two children (C1)(C2) from care to an unathorized parent (P1) that was not fingerprint cleared, associated to the facility, or was an authorized individual on the childrens emergency contact list. Licensee then allowed (P1) to leave the home with the children for approximately 30 minutes which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2022
Plan of Correction
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LPA observed licensee call parent P1 and had P1 bring children C1 and C2 back to the day care.

An Informal Conference meeting will be scheduled at a later date by 6/15/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:George Mingle
LICENSING EVALUATOR NAME:Dean Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022


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