<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216186
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:31:53 AM

Document Has Been Signed on 10/12/2021 11:31 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:CENTENO FAMILY CHILD CAREFACILITY NUMBER:
566216186
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
10/12/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rosalia CentenoTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 12, 2021 at 10:00 AM Licensing Program Analysts (LPAs) Laura Villanueva and Michael Mathew conducted a Prelicensing inspection. LPA asked COVID-19 pre-entry questions prior to entry. LPAs met with Applicant, Rosalia Centeno. A tour of the one-story home was made both inside and outside. Applicant will use the living room, kitchen, one bedroom, and hall bathroom for the child care. There are age appropriate toys and equipment. LPA observed a metal barrier on fireplace. LPA did not observe any toxins/hazardous items accessible to children. All cleaning supplies are in the locked garage. The 2A10BC fire extinguisher was purchased on 10/1/21. Applicant is reminded to service or purchase the fire extinguisher yearly. The combination smoke/carbon monoxide detector was observed in the living room. The Applicant will use the backyard for the childcare. The yard is completely enclosed by a fence with gates. Applicant's Pediatric First Aid/CPR certificate is valid until 2/19/23. Applicant states that there are no guns/weapons on the premises. Applicant completed Mandated Reporter Training on 6/14/21. Health and Safety Training was completed on 5/15/21. Orientation for family child care was completed online on 6/30/21.

LPAs provided Applicant with immunization cards (blue cards), safe sleep pamphlet, lead poisoning information capacity requirements form, and LIC9227 Individual Infant Sleep Plan.

LPA reviewed SB 792 the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA advised the Flu Vaccine may be completed yearly between August 1 - December 1 or complete a waiver.

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

Continued on LIC809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CENTENO FAMILY CHILD CARE
FACILITY NUMBER: 566216186
VISIT DATE: 10/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Applicant was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov. Also, Applicant was reminded that baby walkers, jumpers, bouncers, exersaucers, or any similar article are not permitted on the premises during day care hours.

A small family childcare license is effective today 10/12/21. Inspection and report were translated into Spanish.

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2