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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406214343
Report Date: 11/03/2022
Date Signed: 11/03/2022 04:07:11 PM


Document Has Been Signed on 11/03/2022 04:07 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: 5DATE:
11/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Robin RoseTIME COMPLETED:
04:30 PM
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On 11/3/22, at 1:55 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted a One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Robin Rose, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. The home’s living room, kitchen, guestrooms, hallway bathroom and back- yard are used for child care, while the home’s master bedroom is excluded. At the time of the inspection five children are present, along with an assistant (cleared and associated) providing care and supervision.

LPA observed required licensing forms and documents post on the wall near the entry of the FCCH. LPA observed a fireplace in the living room which is screened by a child safety gate. A combination smoke/carbon monoxide detector is observed in the FCCH. The detector were tested at 3:00 PM and found to be operable.
LPA observed a regulation fire extinguisher in the FCCH's kitchen area which was serviced on 2/15/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill log. The most recent fire drill occurred on 7/8/22.

The home was orderly and the bathroom used for care was clean and free of toxins. LPA observed cleaning compounds on the shelf of an elevated cabinet above the kitchen sink. Household medications are observed on an elevated shelf in a neighboring kitchen cabinet which is also inaccessible to children in care. LPA observed sharps above the oven in the kitchen which is beyond the reach of children in care. Toys, furniture and equipment in the FCCH are age appropriate.

The FCCH's backyard is enclosed by wooden fencing. The backyard fence’s entry/exit gates are secure. Toys and play equipment observed in backyard are age appropriate. LPA observed cushioning material made up of wood bark underneath the play structure in the backyard area. LPA reminded the Licensee to replace play equipment when it begins to degrade or is not in good repair. LPA observed no bodies of water on site.
(CONT. 809-C).
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
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: ROSE FCC AKA DOWNTOWN BABY SHELL BEACH
FACILITY NUMBER: 406214343
VISIT DATE: 11/03/2022
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LPA reviewed children records. All records reviewed are current and complete. The Licensee maintains logs capturing children's sleep in 15 minute intervals, sleep plans as wells as services and need plans. LPA also reviewed the Licensee's records. The Licensee's records are current and complete with Pediatric CPR and First Aid certifications expiring in 6/27/24 (EMSA approved) and Mandated Reporter training expiring on 2/15/24. Licensee informed LPA 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 or additional resource. LPA also informed Licensee 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 Robin Rose.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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