367700110-5-17-2021-12-CC-SMOA-C34PVL-20210517113920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 367700110
Report Date: 05/17/2021
Date Signed: 05/17/2021 11:39:33 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME:	HOLGUIN FAMILY CHILD CARE		FACILITY NUMBER:	367700110
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 5	DATE:	05/17/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Maria Holguin Licensee		TIME COMPLETED:	11:47 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	Licensing Program Analyst (LPA) Steven Montoya met with licensee (TinaMarie Holguin) virtuallty for the purpose of conducting a capacity increase. Applicant is requesting to provide care for a Large Family Child Care Home for the capacity of 14 children. Currently residing in the home, are applicant, spouse and daughter with all adults Criminal Record Clearances (DOJ/FBI and Child Abuse Index. LPA toured home indoor and out to ensure it meets FCCH requirements. Licensee is requesting the days and hours of operation will be: Monday through Friday 7:00 AM - 5 00 PM. Indoor: The home is set up as follows: This is a 1 story home with 3 bedrooms and 2 bathrooms. Per Applicant the following areas of the home with be utilized for the Family Child Care: Living Room, Dining Room, one restroom and the backyard. The off-limits of the home is 3 bedrooms, one bathroom and garage. There is no fireplace located in the home. The home has central heating and air conditioning. The kitchen all sharp utensils, poisons and medications are made inaccessible to children with child safety latches on sink cabinet and drawers. LPA toured and inspected sink/toilet are in operable condition. All unused electrical outlets are plugged and made inaccessible to children. The home is neat and clean and are age appropriate safe toys, and napping equipment observed.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: HOLGUIN FAMILY CHILD CARE	FACILITY NUMBER: 367700110
	VISIT DATE: 05/17/2021

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

The outdoor play area is clean and free from all debris or dangerous conditions. No play equipment is in the backyard is fenced. There is a working cell phone for business. Smoke detectors and carbon monoxide detector tested operable. There is a fully charged fire extinguisher (2A10BC) and fully stocked first aid kit with manual. Applicant states there are no firearms or weapons in the home or on the premises. There is no swimming pool or bodies of water on the premises. Applicant has proof of being immunized against influenza, pertussis and measles. Per applicant no transportation will be provided however, plans to transport children to school upon opening of school. LPA advised licensee to provide proof of DL, Vehicle Insurance and Registration. .

The following was discussed with the Applicant:
Mandatory Forms for the personnel files, Requirements for fire drills, earthquake drills and documentation for both. Role and responsibilities of being a mandated reporter. Applicant reminded that 100% supervision is required at all times to children in care. Applicant was advised how to access forms and Regulations for a large Family Child Care online at www.ccld.ca.gov. Applicant was made aware that it is he/she responsibility to know the regulations as well as anyone who assists in providing care. must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified.

Licensee is also aware MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN; 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.

A copy of this reports was emailed to the licensee for review, scan and return via email.

Exit

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Steven Montoya	TELEPHONE: (661) 568-8932
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2