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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406207846
Report Date: 03/09/2022
Date Signed: 03/09/2022 03:01:55 PM


Document Has Been Signed on 03/09/2022 03:01 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:IBARRA FAMILY CHILD CAREFACILITY NUMBER:
406207846
ADMINISTRATOR:JUANA IBARRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 929-2298
CITY:NIPOMOSTATE: CAZIP CODE:
93444
CAPACITY:14CENSUS: 7DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Juan IbarraTIME COMPLETED:
03:00 PM
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On March 9, 2022 at 12:00 PM Licensing Program Analyst Gigi Reyes conducted an unannounced Required -1 Year Inspection. LPA asked pre-screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Juan Ibarra and discussed the purpose of the inspection. There were 7 children present and 2 staff present during the visit.

LPA and Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) uses the living room for napping , reading and the covered patio for other day care activities. LPA observed aged appropriate toys, chairs and tables and napping equipment. LPA observed required licensing forms are posted in the FCCH. Toxins and hazardous item are kept inaccessible to children in care. The bathroom used by day care children is toxin free. LPA observed smoke and carbon monoxide detectors in the FCCH. The regulation fire extinguisher was serviced on 12/1/2021. Home conducts and documents fire and disaster drill every month, last drill was conducted on 1/6/2022

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 guns and ammunition are stored separately in 2 separate vaults.

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 3/7/2023. Mandated Reporter Training Certificate expires on 12/14/2022. Licensee and Staff have proof of immunization on file.
FCCH has current roster of children in care. Children records were reviewed and found to be current. Emergency and Identification card information is on file. Licensee has liability insurance for FCCH.

No deficiencies were cited during today's inspection.

Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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: IBARRA FAMILY CHILD CARE
FACILITY NUMBER: 406207846
VISIT DATE: 03/09/2022
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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 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, Juana Ibarra
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022
LIC809 (FAS) - (06/04)
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