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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406210936
Report Date: 11/13/2019
Date Signed: 11/13/2019 09:19:12 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:CIPRES FCC AKA LITTLE BUGS CHILDCAREFACILITY NUMBER:
406210936
ADMINISTRATOR:CINDY CIPRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 460-7057
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:14CENSUS: 12DATE:
11/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cindy CipresTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual/random and met with Licensee Ms. Cindy Cipres and Assistant. There were 12 napping children present during the inspection. The home was toured inside and out. Home was observed clean and in order. Age Appropriate toys were observed. Backyard is appropriately fenced. Nobodies of water was observed. Licensee stated there are no guns nor ammunition in the home.

CPR and First Aid expires on 5/27/2020. Licensee and assistant have record of immunization. Fire extinguisher was last serviced on 9/10/2019. Carbon monoxide and smoke detectors are present. Required Licensing forms are posted in the prominent location. Home conducts and documents fire and disaster drill, last drill was conducted on October 16, 2019. Home has current Children's Roster. Children's files were randomly reviewed and found complete. LPA discussed the Safe Sleep Best Practices and Effects of Lead Exposure. Flyers were provided to Licensee.

Home is not providing Incidental Medical Services (IMS). 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.

Continued on 809 C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
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: CIPRES FCC AKA LITTLE BUGS CHILDCARE
FACILITY NUMBER: 406210936
VISIT DATE: 11/13/2019
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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

During today's inspection, no deficiencies were cited under Title 22 Division 12.



LPA observed Licensee posted the Notice of Site Visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2019
LIC809 (FAS) - (06/04)
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