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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216070
Report Date: 01/11/2024
Date Signed: 01/11/2024 09:47:10 AM

Document Has Been Signed on 01/11/2024 09:47 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:BERNAL FAMILY CHILD CAREFACILITY NUMBER:
566216070
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
01/11/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Martha BernalTIME COMPLETED:
10:00 AM
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On January 11, 2024 Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Case Management- Licensee Initiated inspection for an increase of capacity. LPA met with Licensee Martha Bernal and advised her of the purpose for the inspection. Together with the Licensee, LPA toured the facility inside and outside. At the time of inspection there were 7 children in the care of Licensee, no other adults were present in the home. Licensee denies having guns/ammunition in the home.

The single-story home has three bedrooms, two bathrooms, living-room, kitchen, den, and fenced backyard. Licensee uses one bathroom, living-room, kitchen, den, and backyard for day-care use. The fireplace in the living-room was observed to be barricaded by a fence to prevent children from having access. No bodies of water were observed at the time of inspection.

A fire clearance was granted by the Oxnard Fire Department on 12/28/2023.

The home meets Title 22 Regulations for a Large Family Child Care Home (FCCH). Large License is effective today 01/11/2024.

LPA advised Licensee that once licensed for a Large FCCH, the capacity limitations shall be maintained at all times. When there is no Qualified Assistant, the capacity must revert back to the requirements of a Small FCCH. Licensee must notify the parents when caring for more than 12 children using the form LIC9150.
LPA provided a pictorial handout of the capacity requirements for a large FCCH.

No deficiencies were issued during today's inspection.

Notice of site visit was given.

Exit interview conducted and report was reviewed with Licensee, Martha Bernal.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Susana Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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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