<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 401712106
Report Date: 05/27/2022
Date Signed: 05/27/2022 01:49:42 PM


Document Has Been Signed on 05/27/2022 01:49 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: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: 12DATE:
05/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Stacey BakerTIME COMPLETED:
01:50 PM
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
On May 27, 2022 at 10:25 AM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required inspection at Baker Family Child Care Home (FCCH) LPA asked pre- screening questions related to COVID- 19 and Assistan's responses indicate there are no COVID 19 exposures on site. LPA met with Licensee Stacey Baker and assistant, Amanda Geiger and discussed the purpose of the inspection. There were 10 children present during the inspection . Later on the day assistant picked up 2 day care children from the school.

LPA in the company of Assistant toured the interior and exterior of the day care. LPA observed required licensing forms are posted in the FCCH. LPA observed smoke and carbon monoxide detectors in the FCCH. The regulation fire extinguisher was serviced on 2/12/2022. Home conducts and documents fire and disaster drill every month, last drill was conducted on 5/16/2022.

The play yard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 9/14/2023. Licensee and Staff renewed the Mandated Reporter Training Certificate which expires on 7/29/2022. Licensee and Staff have proof of immunization on file. FCCH has current roster of children in care. A sampling of children records was reviewed and found to be current. Licensee carries liability insurance. Assistant checks and documents sleeping infants every 15 minutes.
Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 5


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: 05/27/2022
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
No deficiencies were cited during today's inspection.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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 licensee 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
Licensee was reminded that all adults 18 and over living or working in the home, 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.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee Stacey Baker
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC809 (FAS) - (06/04)
Page: 5 of 5