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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566216567
Report Date: 04/11/2023
Date Signed: 04/11/2023 03:14:52 PM

Document Has Been Signed on 04/11/2023 03:14 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:ANGELES & MENDEZ FCCFACILITY NUMBER:
566216567
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Gabrielle Angeles and Patricia MendezTIME COMPLETED:
03:32 PM
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On April 11, 2023 at 1:30 PM, Licensing Program Analyst (LPA) Austin Rios conducted an announced visit for the purpose of completing a pre-licensing inspection. LPA met with Applicants Gabrielle Angeles and Patricia Mendez and explained the nature and the purpose of the inspection. Applicant provided LPA a tour of the home inside and out. The home is a five bedroom, two bathroom single-story residence. All adults in the home are fingerprint cleared. The applicant will be using the living room, one bathroom, and the court yard.
All bedrooms are locked and off limits.

LPA did not observe any toxins/hazardous items accessible to children. A regulation 2A10BC fire extinguisher purchased on 4/11/2023. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed the home has a functioning smoke and carbon monoxide detectors. There were age appropriate toys and day-care equipment in the home. LPA observed the home to be clean and orderly. Applicant stated they do not have firearms and ammunition in the home. No bodies of water were observed on site. 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.

Preventative Health & Safety and Nutrition Training completed on 9/16/2022. Applicant First Aid/CPR certificate is valid until 9/23/2025. Applicant AB 1207 Mandated Reporter Training Certificate expires 9/5/2024. Orientation completed 8/28/2022. Currently the applicant does not have liability insurance and will be looking into getting some. LPA informed applicant that she will need parents to sign a waiver for the liability insurance should she not have the liability insurance.


Continued on 809-C

SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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: ANGELES & MENDEZ FCC
FACILITY NUMBER: 566216567
VISIT DATE: 04/11/2023
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Applicant provided proof of control of property. 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 advised to monitor the CCLD website for COVID- 19 updates and guidance.
LPA reviewed Covid-19 resources with applicant (RAST Technical Assistance Visit completed).

LPA advised applicant to contact Child development Resources at (805) 485 7878

License to operate a Family Child Care facility is effective today 4/11/2023

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: Austin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC809 (FAS) - (06/04)
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