406213712-2-27-2023-17-CC-GRES-CPFRPA-20230227121138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406213712
Report Date: 02/27/2023
Date Signed: 02/27/2023 12:11:49 PM

Document Has Been Signed on 02/27/2023 12:11 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:	SIVERLING FAMILY CHILD CARE		FACILITY NUMBER:	406213712
ADMINISTRATOR:	SARAH MAE SIVERLING		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 439-0519
CITY:	LOS OSOS	STATE: CA	ZIP CODE:	93402
CAPACITY:	14	CENSUS: 8	DATE:	02/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sarah Mae Siverling		TIME COMPLETED:	12:15 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 February 27, 2023 at 10:00 AM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced One (1) Year Required inspection. 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, Sarah Siverling and spouse/assistant Russel Siverling and explained the purpose of the inspection. The Family Child Care Home (FCCH) operates from Monday to Friday, 8:00 to 5:30 PM. There were 8 children present at the time of the inspection. LPA in the company of Licensee toured the interior and exterior of the day care. Required licensing forms are posted in the wall. LPA observed age appropriate toys, board game activities and equipment. LPA observed smoke and carbon monoxide detectors in the FCCH which were tested and found functional. Fire extinguisher was last serviced on 9/1/2021. Licensee stated it is scheduled to be serviced today. FCCH conducts and documents fire and disaster drill every 6 months, last drill was conducted on 10/11/2022. Bathroom was observed to be clean and free of toxins. Hazardous items and cleaning materials are kept inaccessible to day care children. The backyard is enclosed with appropriate fence equipped with age appropriate play equipment. The hot tub is covered and locked. Licensee stated gun is locked in the safe inaccessible to day care children and no ammunition. LPA reviewed facility file, Pediatric CPR and First Aid expires on 1/15/2025. Licensee and assistant renewed Mandated Reported Training which will expire on 3/12/2024. Licensee and assistant has required immunization record on file, FCCH has current children's roster. A sampling of children records were reviewed and found complete. It contains Emergency and Identification card. FCCH does not carry liability insurance, parents signed the affidavit regarding liability insurance for FCCH (LIC 282) and are in children's file. Continued on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

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: SIVERLING FAMILY CHILD CARE	FACILITY NUMBER: 406213712
	VISIT DATE: 02/27/2023

NARRATIVE

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Licensee does not provide Incidental Medical Services (IMS). 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.

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 years old 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 and. Appeal Rights were given and discussed.

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.
Exit interview conducted and report was reviewed with the licensee, Sarah Siverling

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/27/2023 12:11 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: SIVERLING FAMILY CHILD CARE	FACILITY NUMBER: 406213712
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/27/2023

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 , fire extiguisher was last serviced on 9/1/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/09/2023
	Plan of Correction
1 2 3 4	Licensee stated that the fire extinguisher is scheduled to be serviced today, 2/27/2023. Proof of service is due on or before March 9, 2023

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: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC809 (FAS) - (06/04)

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