406211893-10-6-2022-17-CC-GRES-CJXU4T-20221006151541

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406211893
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:15:49 PM

Document Has Been Signed on 10/06/2022 03:15 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:	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: 3	DATE:	10/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Mary Canche		TIME COMPLETED:	03:15 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	On October 6, 2022 at 12:45 PM, Licensing Program Analyst (LPA), Gigi Reyes conducted an unannounced 1 Year Required Inspection. Licensee was not home when LPA arrived, 5 minutes later Licensee, Ms. Canche showed up with 3 school age children who were identified as Licensee's grandchildren. LPA asked Covid-19 screening questions, licensee's responses indicate there are no COVID 19 exposure on site. Licensee provided LPA a tour of the facility inside and out. Currently, Licensee stated she is caring only for her grandchildren, due to temporary disability. The FCCH is a 2 story home with 5 bedrooms and 3 baths. 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 by a baby gate. During the tour LPA, observed the following, required forms are posted in the wall by the day care area. Appropriate fire extinguisher was serviced on 8/2/2021 LPA observed the dual carbon monoxide and smoke detectors in the home which were tested and found functional. The day care area was observed to be cluttered, Licensee stated she will organize and eliminate some toys and books that are no longer needed. LPA did not observe any bodies of water. Licensee stated there are no guns or ammunition in the home. LPA reviewed the following documents, Pediatric CPR and First Aid Card expires 1/14/2023. Licensee's immunization record is on file. FCCH conducts fire and disaster drill every 6 months, last drill was conducted on 6/13/2022. Licensee's Mandated Reporter Training Certificate will expire on 11/22/2022. Children's roster is current. LPA reviewed children's records, there is a presence of emergency and identification cards on file.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

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: CANCHE FAMILY CHILD CARE	FACILITY NUMBER: 406211893
	VISIT DATE: 10/06/2022

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: http://www.ada.gov/childqanda.html

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.

During today's inspection, deficiency was cited under Title 22 Division 12 and a Technical Violation was issued.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee, Ms. Mary Canche

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/06/2022 03:15 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above, 2 A10 BC fire extinguisher was last serviced on 8/2/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/17/2022
	Plan of Correction
1 2 3 4	Licensee stated she will have the fire extinguiser serviced today, 10/6/2022 and will submit the plan of correction to CCL no later than 10/17/2022

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022

LIC809 (FAS) - (06/04)

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