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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214339
Report Date: 05/03/2022
Date Signed: 10/31/2022 12:58:37 PM


Document Has Been Signed on 10/31/2022 12:58 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:TREJO FAMILY CHILD CAREFACILITY NUMBER:
406214339
ADMINISTRATOR:MARIA REFUJIO TREJOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 709-6928
CITY:OCEANOSTATE: CAZIP CODE:
93445
CAPACITY:14CENSUS: 5DATE:
05/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Maria Refujio TrejoTIME COMPLETED:
04:30 PM
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On 05/03/22, at 1:45 PM Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Maria Refujio Trejo, Licensee of the FCCH and explained the nature and purpose of the inspection. Prior to entering the facility LPA conducted COVID-19 risk assessment and based on Licensee's responses it was determined that the home is free and safe of any COVID-19 exposures. LPA notes five (5) children during this inspection.

LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. The home consists of four (4) bedrooms and two (2) bathrooms. The home’s living room, kitchen and dining area, bathroom and outdoor yard are used for child care services, while the bedrooms, and garage are excluded from services. LPA notes that all bedroom doors were closed and have safety door knob making all bedrooms inaccessible to children in care.

The FCCH is orderly and has ventilation to afford for the children’s comfort and safety. Licensee reported that medication in the FCCH is stored in the Licensee's master bedroom. Sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds were observed to be stored in the children restroom under the sink, in the kitchen under the sink and in the garage. All areas were observed to be inaccessible to children in care. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are posted on the FCCH living room wall. The FCCH has smoke and carbon monoxide detectors which were tested at 3:30 pm and found to be operable. The FCCH has a regulation fire extinguisher which was serviced 02/16/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill documentation. The last drill was completed on 1/07/22. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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: TREJO FAMILY CHILD CARE
FACILITY NUMBER: 406214339
VISIT DATE: 05/03/2022
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The outdoor play yard is completed fenced. LPA notes that the yard affords plenty of shade for the children. LPA observed a locked shed in the outdoor play area. Licensee stated that gardening supplies are stored iin the shed. Drinking water is made accessible by a large water jug and disposable cups. Toys, furniture and equipment observed in the yard are age appropriate. LPA observed no bodies of water on site.


A sampling of the children's records were reviewed. The records are current, complete and possessed emergency contact information. The Licensee's records were also reviewed and found to be complete. Licensee’s Pediatric CPR and First (EMSA approved) expires 06/20/22. Licensee's Mandated Reporter certificate expires on 11/7/22.

The Licensee notes no firearms or ammunition are stored on site.

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 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 and report was reviewed with the licensee, Maria Refujio Trejo. This inspection and review of report was conducted in Spanish due to Spanish being the primary language of the licensee.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
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