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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210090
Report Date: 04/25/2024
Date Signed: 04/25/2024 12:13:10 PM


Document Has Been Signed on 04/25/2024 12:13 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:BALLWEBER FCC AKA JESSIE'S FAMILY DAYCAREFACILITY NUMBER:
406210090
ADMINISTRATOR:JESSICA BALLWEBERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 545-9301
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:14CENSUS: 7DATE:
04/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica BallweberTIME COMPLETED:
12:20 PM
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On 4/25/24, at 9:30 AM, Licensing Program Analysts (LPAs) Elvin Baddley and Joaquin Mendez conducted an unannounced Random/Annual Inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Jessica Ballweber, Licensee of the FCCH and explained the purpose of the inspection. LPAs, in the company of the Licensee, toured the interior and exterior of the FCCH. The FCCH's playroom (converted family room), backyard, hallway restroom and guest rooms (2) are used for child care services, while the remainder of the FCCH is excluded from care. At the time of the inspection, LPAs observed 7 children in care along with an Assistant (cleared and associated) providing care and supervision.

Required licensing forms and documents are posted on a bulletin board in the playroom. LPA observed a smoke and carbon monoxide detector in the FCCH's playroom. Each detector was tested (10:35 AM and 10:36 AM) and found to be operable. The FCCH has a regulation fire extinguisher which was service on 7/30/23. LPAs reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

The home has ventilation to afford for the children’s comfort. Medication in the FCCH is stored in a kitchen cabinet on an elevated shelf, while cleaning products and compounds are also stored on elevated shelves in the home's kitchen cabinet. The bathroom used by children in care is clean and free of toxins. Toys, furniture and equipment observed in the FCCH's interior are age appropriate.

The backyard is enclosed by wooden fencing and partitioned to afford areas for personal use. The footing in the area is varied. LPA observed a trampoline in the area of the backyard for personal use. Licensee informed LPAs the trampoline is not used by children in care. Toys and play equipment observed in backyard are age appropriate. LPA observed a shed is the backyard which contains household supplies and children's equipment. LPA observed the shed to be secure and inaccessible to children in care. LPA observed no bodies of water on site.
(CONT. 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024
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: BALLWEBER FCC AKA JESSIE'S FAMILY DAYCARE
FACILITY NUMBER: 406210090
VISIT DATE: 04/25/2024
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Children's records are reviewed. The records were current, complete and possessed emergency contact information as well as a record of immunization, among other things. The Licensee records are also current and complete with Pediatric CPR and First Aid certifications expiring on 2/15/25. Mandated Reporter Training certification expires on 1/13/25. A review of the FCCH's fire drill log shows the last drill was completed on 4/25/24. The Licensee informed LPAs no firearms or ammunition are stored on site.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

LPAs 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. LPAs 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 in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPAs completed the RSO profile in FAS on 4/5/24.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Jessica Ballweber
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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