406212946-6-27-2022-17-CC-GRES-CFSPQH-20220627113109

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406212946
Report Date: 06/27/2022
Date Signed: 06/27/2022 11:31:16 AM

Document Has Been Signed on 06/27/2022 11:31 AM - 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:	SILVA FCC AKA KIDS IN ACTION		FACILITY NUMBER:	406212946
ADMINISTRATOR:	MARICELA SILVA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 929-3503
CITY:	NIPOMO	STATE: CA	ZIP CODE:	93444
CAPACITY:	14	CENSUS: 10	DATE:	06/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Maricela Silva		TIME COMPLETED:	11:32 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	On 6/27/2022, at 8:45 AM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required inspection at the above Family Child Care Home (FCCH) LPA asked pre-screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Ms. Maricela Silva and explained the purpose of the visit. There were 10 children and 2 staff present at the time of the inspection. LPA in the company of Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) uses the family room, a bedroom, bathroom adjacent to the family room, the converted garage for additional classroom activities, and the fenced play yard located in the front yard of the home. LPA observed required licensing forms are posted in the FCCH. LPA observed smoke and carbon monoxide detectors in the home. The regulation fire extinguisher was serviced on 9/3/2021. Home conducts and documents fire and disaster drill every 6 months months, last drill was December 13, 2022. The play yard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires 4/27/2023. Licensee and Assistant did not take the Mandated Reporter training per AB 1207. Licensee and Assistant have proof of immunization on file. FCCH has current roster of children in care. A sampling of children records were reviewed. File contains Emergency and Identification card requirements.. Licensee documents and checks napping infants every 15 minutes. However, Infant # 2 does not have LIC 9227 Individual Safe Sleep Plan on file Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

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: SILVA FCC AKA KIDS IN ACTION	FACILITY NUMBER: 406212946
	VISIT DATE: 06/27/2022

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 Home 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.

During today's inspection, deficiencies were cited under Title 22 Division 12.

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.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Ms. Maricela Silva

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/27/2022 11:31 AM - 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: SILVA FCC AKA KIDS IN ACTION	FACILITY NUMBER: 406212946
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Licensee and Staff did not take/renew the Mandated reporter training per AB 1207 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Licensee and assistant agreed to take Mandated Reporter Trainng per AB 1207 and submit proof to Community Care Licensing (CCL) no later than 7/7/2022 to

Type B

Section Cited

CCR

102425(c)

Infant Safe Sleep

An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Infant # 2 does not have Infant Safe Sleep Plan (LIC 9227) on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Licensee agreed to obtain parents signature for LIC 9227 and moving forward licensee understood that Individual Safe Sleep Plan is required for Infant 0-12 months old. Written plan of correction will be submitted to CCL no later than 7/7/2022.

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: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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