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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216291
Report Date: 05/11/2022
Date Signed: 05/11/2022 01:15:28 PM

Document Has Been Signed on 05/11/2022 01:15 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:IZA FCCHFACILITY NUMBER:
566216291
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
05/11/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Aurora IzaTIME COMPLETED:
01:30 PM
NARRATIVE
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On May 11, 2022 at 10:45 AM, Licensing Program Analyst (LPA) Dean Thompson and Susana Martinez conducted an announced Pre-licensing inspection. Prior to entering the facility, LPA spoke to licensee Aurora Iza and conducted a COVID-19 risk assessment. All answers indicated no exposure to COVID-19. LPA discussed the nature and purpose of the inspection. Licensee and LPA toured the facility inside and outside. There were no children in care at the time of the inspection.

This home has five bedrooms, 4 bathrooms, living room, kitchen, dining room, garage, and back yard that is enclosed. Licensee stated Kitchen, living room, dining room, master bedroom, one bathroom and backyard will be utilized for children in care.

Kitchen cabinets and drawers have safety locks. LPA observed doors to be locked and/or equipped with child safety handles preventing children from gaining access. Detergents and cleaning compounds are stored outside.

Children have access to toys that are age-appropriate inside and outside of the home. Licensee stated there are no firearms or ammunition inside the home. There are no bodies of water present at the time of inspection. Fire and carbon monoxide alarms were tested and working. Fire extinguisher 2A10BC is fully charged with a purchase date of 4/1/2022. Applicant is reminded to service or purchase the fire extinguisher yearly.

Licensee's Pediatric First Aid/CPR certificate is valid through 3/8/2024. Licensee was reminded to renew her certification every two years. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com

Continued on LIC 809-C

SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Dean Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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: IZA FCCH
FACILITY NUMBER: 566216291
VISIT DATE: 05/11/2022
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Incidental Medical Services (IMS) policy was discussed. For IMS information , see PIN 22-02-CCP. 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

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Licensee, was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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 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 [applicant, licensee, or facility representative] 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.

Continued on LIC 809-C

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

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
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: IZA FCCH
FACILITY NUMBER: 566216291
VISIT DATE: 05/11/2022
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Licensee stated she converted the garage into a rental and has two adults (A1 & A2) living inside. The converted garage has one room and one restroom.

Licensee also converted two other rooms in the home into rentals. One room is located South East of the property and is being occupied by (A3). In order to gain access to this room, you would have to so by entering the entrance near the South end of the garage.

One room is located on the North end of the property and has adult (A4) present. In order to gain access to the room, you would have to do so from the front or back yard.

Issuance of Small Family Child Care Home License is pending subject to completion of the following:


1. LIC 279 Submit new application with the names of all adults on the property
2. LIC 508 Criminal Record Statement for all adults living on the property
3. LIC 9163 Live Scan submission for all adults on the property
4. Tuberculosis TB Clearance for all adults
5. Removal of all medications/hazardous items inside day-care restroom
6. Submit new facility sketch

No deficiencies cited during this visit.

Exit interview conducted and report was reviewed with the licensee Aurora.

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

DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022
LIC809 (FAS) - (06/04)
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