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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401712106
Report Date: 08/26/2019
Date Signed: 08/26/2019 04:56:21 PM

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:BAKER FCC AKA STACEY'S DAYCAREFACILITY NUMBER:
401712106
ADMINISTRATOR:STACEY JOLANE BAKERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 434-5589
CITY:TEMPLETONSTATE: CAZIP CODE:
93465
CAPACITY:14CENSUS: 11DATE:
08/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Stacy BakerTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced annual/random visit and met with licensee Stacy Baker and her Assistant. The home was toured inside and out. All required forms are posted in a prominent location. There were 11 children present, 4 being infants. This is a three (3) bedroom home. The master bedroom is off limits and is made inaccessible by child proof lock. Bathroom used by children was observed to be clean and free of toxins. There is a nap room with four pack n play cribs. The third bedroom is a child's bedroom and is not used regularly by day care children. The indoor activity room is off of the open plan kitchen and dining room. LPA observed age appropriate toys, books and games. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. The backyard is completely fenced, is equipped with age appropriate toys and is shaded. Drinking water is available inside and outside via individual water bottles. There are no bodies of water.

Fire extinguisher was serviced on 5/16/19. Carbon monoxide and smoke detectors were tested and operational. Licensee completes and documents emergency drills. The most recent drill was held on 8/16/19. Licensee and Assistant are CPR and first aid certified through 10/2/19. Licensee and assistant have met immunization requirement and completed the AB 1207 Mandated Reporter Training on 9/10/18. Children's records were randomly reviewed and found complete. Licensee maintains a log to demonstrate that all families have received the “Effects of Lead Exposure” brochure. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
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: BAKER FCC AKA STACEY'S DAYCARE
FACILITY NUMBER: 401712106
VISIT DATE: 08/26/2019
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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: www.ada.gov/childqanda.htm

LPA reviewed and provided Licensee with a copy of “Child Care Providers Guide to Safe Sleep.” Licensee was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

In the areas evaluated, no deficiency cited.

LPA observed Licensee post the Notice of Site visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2