<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 04/24/2024
Date Signed: 04/24/2024 03:27:25 PM


Document Has Been Signed on 04/24/2024 03:27 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:ROSE FCC AKA DOWNTOWN BABY SHELL BEACHFACILITY NUMBER:
406214343
ADMINISTRATOR:ROBIN ROSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 888-9504
CITY:PISMO BEACHSTATE: CAZIP CODE:
93449
CAPACITY:14CENSUS: 9DATE:
04/24/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Janeli HernandezTIME COMPLETED:
03:35 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 4/24/24, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Case Management Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Janeli Hernandez, Assistant of the FCCH. It should be noted Robin Rose, Licensee of the FCCH, was not on site at the time of the inspection. LPA explained the nature of the inspection. LPA notes nine children are on site with another Assistant providing supervision.

LPA inquired the status of the Licensee. LPA was informed by Assistants Licensee has not been on site since Monday 4/22/24. In essence, the FCCH has operated without the presence of Licensee on site since 4/22/24. LPA reminded Assistant Licensee must be on site at least 80% of the day. Licensee's absence from the home should not exceed 20%.

A Type B Deficiency are being cited based on LPA’s observations pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D).

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Assistant.

Assistant was provided a copy of their Appeal Rights (LIC 9058). The LIC 9213 (Notice of Site visit) was provided and must remain posted for 30 days..

Exit interview conducted and report was reviewed with the Facility representative Janeli Hernandez.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
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


Document Has Been Signed on 04/24/2024 03:27 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: ROSE FCC AKA DOWNTOWN BABY SHELL BEACH
FACILITY NUMBER: 406214343

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/01/2024
Section Cited
CCR
102417(a)

1
2
3
4
5
6
7
The licensee shall be present in the home...Temporary absences shall not exceed 20 percent of the hours that
the facility is providing care per day. This requirement was not met as evidenced by Licensee no being at the FCCH on 4/22/24, 4/23/24 and 4/24/24 according
1
2
3
4
5
6
7
Licensee to submit an written plan explaining how Licensee will maintain presence at the FCCH 80% per day, and alternative plans should Licensee absence exceed 80%.Plan of Correction to be provided to CCLD (elvin.baddley @dss.ca.gov) no later than 5/1/24.
8
9
10
11
12
13
14
to the FCCH Assistants. This poses a potential health, safety or personal rights risks to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2