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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216470
Report Date: 11/01/2022
Date Signed: 11/01/2022 12:44:37 PM

Document Has Been Signed on 11/01/2022 12:44 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:HUBBELL FAMILY CHILD CAREFACILITY NUMBER:
566216470
ADMINISTRATOR:KELLIE HUBBELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 320-1059
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Kellie HubbellTIME COMPLETED:
01:12 PM
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This is a change of location, the previous facility no. was 566214138.

On November 01, 2022, at 10:28 AM, Licensing Program Analyst (LPA) Rona Chavez conducted an announced change of location Pre-licensing inspection. LPA met with licensee/applicant Kellie Hubbell and conducted a COVID-19 risk assessment. 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.

Licensee Kellie Hubbell applied for Change of Location. The home is single story with 3 bedrooms, a play room and two bathrooms. The applicant will use the play room, kitchen, one bathroom and the back yard for the day-care. LPA observed the living room to have a fire place with a metal screen preventing the children from having access. The 3 bedrooms are inaccessible to day care children with lock in each door. There are age appropriate toys, teaching materials, and furnishings in good condition and free of hazards. The back yard is fully enclosed with a brick wall. LPA did not observe any toxins/hazardous items accessible to children. Cleaning agents, disinfectants are stored in the hall closet on the top shelf. A regulation 2A10BC fire extinguisher was purchased on 10/09/2022. Applicant is reminded to service or purchase the fire extinguisher yearly.

Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2022
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: HUBBELL FAMILY CHILD CARE
FACILITY NUMBER: 566216470
VISIT DATE: 11/01/2022
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LPA observed the smoke and carbon monoxide detectors in the home to be orderly. Licensee stated that there are no guns or ammunition in the home. The Control of Property and Liability Insurance was reviewed.

Licensee completed the Child Abuse Mandated Reporter Training and will expire on 10/09/2024. Licensee has current CPR/First Aid certificate on file that expires on 07/09/2024. LPA discussed COVID-19 Mitigation Plan/Self Assessment. LPA reviewed forms to keep on file with licensee.
LPA discussed and verified SB 792 (Child Care Employee and Volunteer: Immunization and Tuberculosis Requirements). Applicant was informed walkers, bouncers, and any similar object that restricts children's movement is prohibited from licensed facilities.

LPA reviewed, discussed and gave applicant updated samples of state required forms to be kept in the children's file, required forms to be posted, and forms that needs to be maintained at the Family Child Care Home (FCCH). LPA discussed information about Sudden Infant Death Syndrome, Never Shake a Baby, and Capacity requirements. LPA discussed Safe Sleep regulations with applicant. Applicant was made aware that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.cdss.ca.gov.

Applicant 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.

Cont. LIC 809C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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: HUBBELL FAMILY CHILD CARE
FACILITY NUMBER: 566216470
VISIT DATE: 11/01/2022
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LPAs discussed the safe sleep regulations with applicant, 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. LPAs also informed applicant 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.

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



License to operate a Family Child Care facility is effective today 11/01/2022.

A copy of this report was reviewed and provided to the applicant. Notice of Site visit posted (LIC9213).

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Rona Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC809 (FAS) - (06/04)
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