406211893-2-19-2020-17-CC-CPAN-BLXPNW-20200219102838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406211893
Report Date: 02/19/2020
Date Signed: 02/19/2020 10:28:44 AM

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:	CANCHE FAMILY CHILD CARE		FACILITY NUMBER:	406211893
ADMINISTRATOR:	MARY CANCHE		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 904-3030
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	14	CENSUS: 2	DATE:	02/19/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Mary Canche		TIME COMPLETED:	10:35 AM

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	Licensing Program Analyst (LPA) Christian Patterson made an unannounced inspection to the home for the purpose of conducting a Required 1-year inspection. LPA met with Licensee Mary Canche and explained the purpose of the inspection. There were 2 children present. A tour of the home was made both inside and outside. Licensee uses the living room, kitchen, backyard, a playroom, and hall bathroom for the day care. The bedrooms are off-limits/locked as well as the second story which is made inaccessible with a gate. The regulation fire extinguisher was serviced on 09/16/19. Licensee is reminded to either service or purchase a regulation fire extinguisher every year. The smoke and carbon monoxide detector were observed to be functional. Licensee uses the backyard is completely enclosed with a fenced. LPA did not observe any bodies of water. Licensee stated that there are no firearms/ammunition in the facility. LPA observed that there are age appropriate toys and equipment both inside and outside. LPA reviewed a sampling of children's records. Immunization records were complete for all adults in the facility. Licensee's First Aid/CPR certificates are valid until 01/08/2021. Licensee completed AB 1207 Mandated Reporter Training on 11/29/18. A fire/disaster drill was completed on 12/11/19. 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

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian Patterson	TELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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: CANCHE FAMILY CHILD CARE	FACILITY NUMBER: 406211893
	VISIT DATE: 02/19/2020

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Licensee is reminded that they are responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPA reviewed the handouts "Safe Sleep in Child Care, A Child Care Provider's Guide to Safe Sleep, and the Effects of Lead Exposure".

There were no deficiencies cited today. The LIC 9213 (Notice of Site Visit) was posted in LPA's presence.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Christian Patterson	TELEPHONE: (805) 315-8362
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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