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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216146
Report Date: 07/08/2021
Date Signed: 07/08/2021 09:36:52 AM

Document Has Been Signed on 07/08/2021 09:36 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:ANDRADE FAMILY CHILD CAREFACILITY NUMBER:
566216146
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/08/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Alicia AndradeTIME COMPLETED:
09:42 AM
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This is a change of location, previous facility number 426215394

On 7/8/2021 at 8:35 AM, Licensing Program Analyst (LPA) Austin Rios conducted an announced change of location Pre-licensing inspection. LPA conducted a Pre-screening with licensee prior to entering the FCCH. LPA met with licensee Alicia Andrade. LPA discussed the nature and purpose of the inspection. LPA toured the home with licensee. The licensee will be using the dining room, living room, backyard, and one bathroom for the day care. LPA observed a gate in front of the stairs making it inaccessible to children in care. The bedrooms, kitchen, and garage will be off limits. There were no children in care at the time of the inspection. LPAs did not observe any toxins/hazardous items accessible to children.

A regulation 2A10BC fire extinguisher which was purchased on February 2021 was observed in the dining room readily accessible. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed and tested the smoke and carbon monoxide detectors in the home. There are age appropriate toys and day-care equipment in the home. The back yard has age appropriate toys and day-care equipment. LPA advised licensee must provide visual supervision while the children are playing outside in the backyard. Licensee First Aid/CPR certificate is valid until 6/2023. Licensee stated that they do not have any firearms and ammunition in the home.

Cont on 809 C.
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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: ANDRADE FAMILY CHILD CARE
FACILITY NUMBER: 566216146
VISIT DATE: 07/08/2021
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LPA verified SB 792 (child care employee and volunteer: Immunization and Tuberculosis Requirements). 1207 Mandated Reported Training Certificate dated 7/5/2021. Licensee was informed walkers, bouncers, and any similar objects that restricts child movements is prohibited from licensed facilities. LPAs spoke with licensee regarding safe sleep regulations.

Incidental Medical Services (IMS) was discussed. 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. License granted and effective today 7/8//2021

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: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
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