406214142-10-5-2022-17-CC-FPEA-CJWTWS-20221005150602

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406214142
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:06:07 PM

Document Has Been Signed on 10/05/2022 03:06 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:	FLORES FCC AKA GENESIS FAMILY CHILD CARE		FACILITY NUMBER:	406214142
ADMINISTRATOR:	FLORES, CARMEN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 286-4209
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	14	CENSUS: 11	DATE:	10/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:47 PM
MET WITH:	Carmen Flores		TIME COMPLETED:	03:20 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 5, 2022 at 1:45 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with Licensee Carmen Flores and advised her the purpose of the inspection. Licensee provided LPA a tour of the facility inside and out. There were 11 children in care and one (1) assistant supervising during the inspection. Licensee uses the two living rooms, one (1) bedroom, one (1) bathroom, and the backyard for children in care. The kitchen, two (2) bedrooms, and garage is off limits to the children. LPA observed a 2A10BC fire extinguisher mounted on the wall with a service date of 1/25/22. Licensee advised that she must purchase or service the fire extinguisher annual. Licensee has working smoke and carbon monoxide detectors. During the inspection LPA observed the facility had age appropriate toys, furniture, and activities available for children in care. Licensee provide sleeping cots for children that are sleeping and travel play pins for infants. The backyard is enclosed with a wood fence. LPA observed age appropriate toys and structures available for the children to use outside. The facility provides water to children inside and out. Licensee does not have firearms or live ammunition in the home. LPA reviewed a sampling of children and staff records. The children and staff records were found to be current and complete. Facility staff met the requirements for Mandated Reporter and CPR/First-Aid. LPA spoke with licensee about current Covid-19 requirements. Licensee is following current guidelines. No deficiencies were cited during today's inspection. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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: FLORES FCC AKA GENESIS FAMILY CHILD CARE	FACILITY NUMBER: 406214142
	VISIT DATE: 10/05/2022

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.

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.

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 additional resource. LPA also informed licensee [facility representative] 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

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC809 (FAS) - (06/04)

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