406214343-2-27-2020-17-CC-MKST-BM7VMW-20200227153413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 02/27/2020
Date Signed: 02/27/2020 03:34:21 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:	SIMONIAN FCC AKA HOPE FAMILY CHILD CARE		FACILITY NUMBER:	406214343
ADMINISTRATOR:	ROBIN ROSE SIMONIAN		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 888-9504
CITY:	PISMO BEACH	STATE: CA	ZIP CODE:	93449
CAPACITY:	14	CENSUS: 5	DATE:	02/27/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Robin Rose Simonian		TIME COMPLETED:	03:40 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 2/27/20 at 3pm, Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced Annual/Random inspection and met with Licensee, Robin Rose Simonian. The purpose of the inspection was explained and the home was toured inside and out. All required forms are posted in a prominent location. At the time of inspection, there were 5 children (2 being infants) supervised by Licensee. The family child care home operates in the living room, dining area, two bedrooms and backyard of the home. LPA observed age appropriate toys, books and furnishings in the indoor activity areas. The third bedroom is off limits and is made inaccessible by a child proof door knob lock. The bathroom used by children was observed to be clean and free of toxins. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. Outdoors, LPA observed shaded area, garden, playhouse, water play table, riding toys, sidewalk chalk, and a slide located on wood chips. The backyard is completely fenced; there are no bodies of water. The combination carbon monoxide/smoke detector was observed to be operational. LPA observed the 2 A10 BC fire extinguisher which was purchased on 2/4/20. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 2/3/20. Licensee's Pediatric CPR and first aid certification expired on 2/3/20. Licensee reported that she is scheduled to attend a re-certification class on 3/7/20. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

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 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: SIMONIAN FCC AKA HOPE FAMILY CHILD CARE	FACILITY NUMBER: 406214343
	VISIT DATE: 02/27/2020

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
26
27
28
29
30
31
32

Licensee has met SB 792 immunization requirement. Mandated Reporter Training per AB 1207 was completed by Licensee on 2/24/20. Facility roster and a sample of children's records were reviewed and found complete. Licensee stated that there are no children enrolled who require medications at this time.

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: www.ada.gov/childqanda.htm

LPA reviewed and provided Licensee with Safe to Sleep brochure. Licensee reported that she provides “Effects of Lead Exposure” brochure to all families. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov. Licensee reported that she receives important updates from Community Care Licensing Division via email.

In the areas evaluated, no deficiency cited.

LPA observed Licensee post the Notice of Site visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2