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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406213645
Report Date: 08/02/2022
Date Signed: 08/02/2022 04:52:37 PM


Document Has Been Signed on 08/02/2022 04:52 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:EVANOFF FAMILY CHILD CAREFACILITY NUMBER:
406213645
ADMINISTRATOR:EVANOFF, RHONDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 541-0907
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY:14CENSUS: 9DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rhonda EvanoffTIME COMPLETED:
04:45 PM
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On 8/2/22, at 2:00 PM Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Licensee Rhonda Evanoff and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The FCCH’s converted ground guest room, dining room, living room, backyard, converted garage, upstairs bedrooms and hallway restroom are used for childcare services. At the time of the inspection 9 children (one biological) are present along with Assistant/spouse Joshua Evanoff.

The home is clean, orderly and has ample ventilation to support the children’s comfort and safety. LPA observed the home is void of hazardous items. Medication and sharps are stored on an elevated shelf in a kitchen cabinet which is above the refrigerator and beyond the reach of children in care. Medication is also stored in the bathroom of the master bedroom which is inaccessible to children in care. LPA observed cleaning compounds stored underneath the kitchen sink which is secured by a child safety lock. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are predominantly posted in FCCH. LPA observed a fireplace in the living room which is screened by glass. Additionally, LPA observed a child safety gate at the base and top of the stairwell which serves as a barrier to the home's stairs. LPA observed the restroom used for care to be free of toxins and hazards. The FCCH has combination smoke and carbon monoxide detector which were tested (4:30 PM) and found to be operable. LPA observed a regulation fire extinguisher in the FCCH which was service on 8/2/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill logs. The most recent fire/disaster drill occurring on 7/8/22. The FCCH maintains operable telephone services.

The backyard is enclosed by wooden fencing. The fence’s entry/exit gates are secure. The back yard also has (CONT.809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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: EVANOFF FAMILY CHILD CARE
FACILITY NUMBER: 406213645
VISIT DATE: 08/02/2022
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three sheds which contains yard tools, equipment and supplies. The sheds were all secured by lock. The backyard contains a converted garage which is equipped with child appropriate toys and furnishing. Likewise, toys, equipment and play structures observed in backyard are age appropriate. No bodies of water are observed on site.

Children records are reviewed. The records are current and complete with children contact emergency information as well as immunization records. Licensee also had documentation noting safety checks of children ages 0-24 months in 15 minute intervals. LPA also reviewed the Licensee’s records which are current and complete with Pediatric CPR and First Aid certifications expiring on 1/28/23, and Mandated Reporter Training expiring 7/8/23. LPA observed two dogs on site. The vaccination records for the dogs were reviewed and found to be current. A firearm and ammunition is on stored on site. The aforementioned are secured and stored separately.

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

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.

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 for 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.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Rhonda Evanoff.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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