566216139-8-31-2021-17-CC-BCES-C6EQHN-20210831121125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566216139
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:11:38 PM

Document Has Been Signed on 08/31/2021 12:11 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:	GARCIA GUEVARA FAMILY CHILD CARE		FACILITY NUMBER:	566216139
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/31/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Patricia Garcia Guevara		TIME COMPLETED:	12:15 PM

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On August 31, 2021 at 10:00AM, Licensing Program Analyst (LPA) Betzayra Cervantes conducted an announced visit for the purpose of performing a pre-licensing inspection. Prior to entering the facility, LPA spoke to applicant Patricia Garcia Guevara and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Applicant and LPA toured the facility inside and outside. There were no children in care at the time of the inspection.

The home is a four bedroom, two bath single story manufactured home. The applicant will use the living room, one bedroom, one bathroom, kitchen, and front porch for the day-care. The 3 bedrooms and 1 bathroom are off limits and the rooms are locked with a key making them inaccessible to children in care. In the bedroom that will be used for daycare, LPA observed a closet which has personal belongings and vitamins accessible to children. Applicant stated that she will be installing a latch to prevent access. There are age appropriate toys and furnishings in good condition and free of hazards. Applicant will be using the front porch as part of her daycare. There is a set of stairs of that leads to the front porch and front of the home. Applicant stated that she will be installing a gate at the base of the stairs preventing children from going out into the driveway. LPA observed one locked storage shed located in the side yard which is off limits. There is a gate on the opposite side of the front porch which leads to the sideyard which is inaccessible. All adults in the home are fingerprint cleared. LPA did not observe any toxins/hazardous items accessible to children. LPA observed one small dog inside of the home. Applicant reported that the dogS vaccinations are up to date.

LPA observed a 2A10BC fire extinguisher mounted on the kitchen wall. Applicant was unable to locate the receipt with the date of purchase. LPA advised that proof of purchase will need to be submitted prior to licensure. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA had applicant test dual smoke and carbon monoxide detectors in the home and were found operational.

Continued on 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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: GARCIA GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 566216139
	VISIT DATE: 08/31/2021

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LPA observed the home to be orderly. No bodies of water were observed on site. Applicant stated that there are no guns or ammunition in the home. Detergents and cleaning compounds are stored out of reach of children. The bathroom to be used for children in care was observed to be clean and sanitary. Applicant states the home does not currently have liability insurance. LPA informed applicant that parents will need to sign a waiver for the liability insurance if insurance is not obtained (applicant was provided form- LIC 282).

Applicant's Pediatric First Aid/CPR certificate is valid until 03/08/2023. Applicant was advised that Mandated Reporter training is required prior to licensure. Applicant submitted Ventura County Secured Tax Statement to verify control of property. Preventative Health and Safety and Nutrition Training completed on 02/27/2021.

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.html

LPA issued the applicant updated samples of state required forms to be kept in the children's records. LPA also discussed and provided Guidelines to Safe Sleep and Effects of Lead Exposure leaflets. Applicant was provided PIN 20-24-CCP - Recently Approved Safe Sleep Regulations In Effect and LIC 9227 (Infant Sleeping Plan). Applicant was informed that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours. Applicant were made aware of the responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

LPA reviewed COVID-19 guidelines/resources with applicant (RAST Technical Assistance Visit completed). LPA also reminded applicant to continue monitoring the CCLD website for COVID-19 updates and guidance.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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: GARCIA GUEVARA FAMILY CHILD CARE	FACILITY NUMBER: 566216139
	VISIT DATE: 08/31/2021

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Based on the LPA’s observation, the following corrections need to be corrected prior to obtaining a small family child care license. Corrections are due by 09/14/2021.

1. Applicant will submit a receipt or proof of service for fire extinguisher.
2. Applicant needs to install a barrier on the front porch blocking off the off the base of the stairs.
3. Applicant must make the closet located inside the bedroom that will be used for children inaccessible.
4. Mandated Reporter Training Certificate (Child Care Provider)

Licensure is pending following receipt of corrections. Once licensed, the applicant is required to comply with the terms and limitations stated on the license. Exit interview was conducted with applicant Margarita Rico. A copy of this report was reviewed and provided to the applicant.

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: George Mingle
LICENSING EVALUATOR NAME: Betzayra Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC809 (FAS) - (06/04)

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