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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214142
Report Date: 03/02/2020
Date Signed: 03/02/2020 12:47:34 PM

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:FLORES FCC AKA GENESIS FAMILY CHILD CAREFACILITY NUMBER:
406214142
ADMINISTRATOR:FLORES, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 286-4209
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:14CENSUS: 5DATE:
03/02/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Carmen FloresTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Annual/Required and met with Licensee's daughter/Assistant, Cassandra Flores. Licensee, Carmen Flores came 10 minutes after. There were 5 children present during the inspection. The home was toured inside and out. There were 3 bedrooms and two baths. Kitchen, bedrooms and garage are not accessible to day care children. Age appropriate toys were observed. Backyard is appropriately fenced. Nobodies of water were observed. Licensee stated there are no guns or ammunition in the home. The cleaning compounds, detergents, and hazardous items such as knives are kept inaccessible to day care children. The bathroom is free of toxin.

CPR and First Aid expires on 03/20/2021. Licensee and assistants have complete record of immunization. Fire extinguisher was last serviced on 08/20/2019. Staff have not renewed the AB 1207 Mandated Reporter Training. Licensee was made aware that AB 1207 should be renewed every 2 years. Carbon monoxide and smoke detectors are present and functional. Required Licensing forms are posted in the prominent location. Home conducts and documents fire and disaster drill every month, Last time drill was conducted was January 2020. Home has current Children's Roster. Children's files were randomly reviewed and found complete.

Continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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 3
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: FLORES FCC AKA GENESIS FAMILY CHILD CARE
FACILITY NUMBER: 406214142
VISIT DATE: 03/02/2020
NARRATIVE
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LPA discussed the Guide to Safe Sleep, U.S. Consumer Safety Products and Equipment Recall. Effects of Lead Exposure Flyers were provided to Licensee for distribution to parents of day care children.

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

In the areas evaluated deficiency was cited under Health and Safety Code in the attached 809 D. Appeal Rights Given.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.



LPAs observed licensee post the Notice of Site visit.
FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: FLORES FCC AKA GENESIS FAMILY CHILD CARE
FACILITY NUMBER: 406214142
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/02/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2020
Section Cited

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b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...

This requiremen tis not met as evidenced by:
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Based on LPA's review of Facility record and interview with licensee, licensee and Staff have not renewed the AB1207 Mandated Reporter Training. This poses a potential risk to health and safety of children in care.
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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 MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3