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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406207770
Report Date: 04/14/2023
Date Signed: 04/14/2023 04:16:17 PM


Document Has Been Signed on 04/14/2023 04:16 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
406207770
ADMINISTRATOR:MARIANA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 481-4863
CITY:OCEANOSTATE: CAZIP CODE:
93445
CAPACITY:14CENSUS: 4DATE:
04/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Mariana PerezTIME COMPLETED:
12:30 PM
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On 04/14/2023 at 10:40 AM, Licensing Program Analysts (LPAs) Francisca Velazquez and Giovani Gonzalez conducted an unannounced Required 1 Year inspection of the facility. The LPAs met with Mariana Perez, Licensee of the FCCH and explained the purpose of the inspection. LPAs, in the company of Licensee, toured the interior and exterior of the FCCH. LPAs observed four (4) children in care during today’s inspection.

This home consists of three (3) bedrooms, (2) bathrooms and has attached permitted garage with its own bathroom. LPAs notes the home is off-limits to children in care. Day care services occur in the permitted garage which has it’s own bathroom and the outdoor area.

The home was clean, orderly and has ventilation to afford for the children’s comfort and safety. Further, the home was void of hazardous items. LPAs observed sharps, medication for the family and cleaning solutions/toxins are in the main house of the FCCH. LPAs note that all the house is off-limits to the children by means of a locked door that leads into the home. Toys, furniture and equipment observed in the home are safe, varied and age appropriate.

Required forms are predominantly posted on the wall of the converted garage. LPAs observed and tested smoke and carbon monoxide detectors at 11: 00 AM and note both were operable during inspection. The home has a regulation fire extinguisher which was serviced on 04/04/23. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services.



During the tour of the outdoors, LPA note the outdoors is completely fenced. LPAs observed a shed in the backyard that was locked and inaccessible to children in care. LPAs observed plenty of shade, gross motor activities with cushion in all fall zones accessible to children in care. The fence’s entry/exit gates were secure. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2023
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: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 406207770
VISIT DATE: 04/14/2023
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Toys and play equipment observed in backyard are safe, varied, age appropriate and in satisfactory condition. Licensee ensures children have access to filtered drinking water by means of individual water cups that are labeled. No bodies of water were observed on site.

LPAs reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records. Today there are no infant age children present, therefore LPAs verified 15 min. sleep logs of infants enrolled in the FCCH. A review of the FCCH's fire drill log shows the last drill occurred 3/16/23. The Licensee's records were reviewed. Licensee’s pediatric CPR and First Aid certification was taken on 01/12/23 . Licensee’s Mandated Reporter training certificate was taken 09/02/2022.



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

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.

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 for 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.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Mariana Perez in spanish due to spanish being licensee's primary language.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
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