406208842-12-11-2019-17-CC-MKST-BJS2JT-20191211162651

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406208842
Report Date: 12/11/2019
Date Signed: 12/11/2019 04:26:58 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:	PLASCENCIA FAMILY CHILD CARE		FACILITY NUMBER:	406208842
ADMINISTRATOR:	JOSEFINA PLASCENCIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 474-9801
CITY:	OCEANO	STATE: CA	ZIP CODE:	93445
CAPACITY:	14	CENSUS: 6	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:35 PM
MET WITH:	Josefina Plascencia		TIME COMPLETED:	04:35 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	(1)Licensing Program Analyst (LPA), Melissa Stewart, conducted an unannounced annual/random inspection and met with licensee, Josefina Plascencia. The purpose of the inspection was explained and the home was toured inside and out. All required forms are posted near the front entrance of the home. At the time of inspection, there were 6 children supervised by licensee. The family child care home operates in the indoor activity area in the garage. The upstairs is off-limits and is made inaccessible by a child safety gate. LPA observed age appropriate toys, books and furnishings in the indoor activity area. The bathroom used by children was observed to be clean and free of toxins. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. LPA observed art easel, playhouse, bikes and toys in the backyard which is completely fenced; there are no bodies of water. Carbon monoxide and smoke detectors were tested and operational. LPA observed the 2 A10 BC fire extinguisher which was serviced on 4/16/19. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 6/18/19. Licensee's Pediatric CPR and first aid certification expires on 3/9/21. Licensee has met SB 792 immunization requirement. Facility roster and a sample of children's records were reviewed and found complete. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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: PLASCENCIA FAMILY CHILD CARE	FACILITY NUMBER: 406208842
	VISIT DATE: 12/11/2019

NARRATIVE

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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 Safe to Sleep brochure in Spanish. LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and 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.

Licensee's adult son translated this report in Spanish for Licensee.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

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