406214901-6-6-2024-17-CC-EBAY-D5YTRU-20240606145808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406214901
Report Date: 06/06/2024
Date Signed: 06/06/2024 02:58:12 PM

Document Has Been Signed on 06/06/2024 02:58 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:	CERVANTES FAMILY CHILD CARE		FACILITY NUMBER:	406214901
ADMINISTRATOR:	MACRINA CERVANTES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 473-1952
CITY:	OCEANO	STATE: CA	ZIP CODE:	93445
CAPACITY:	14	CENSUS: 7	DATE:	06/06/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Macrina and Juan Cervantes		TIME COMPLETED:	03:00 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 6/6/24, at 12:45 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Macrina Cervantes, Licensee of the FCCH. As the Licensee is primarily Spanish speaking, the Licensee's Assistant/spouse Juan Cervantes, assisted with communication between LPA and Licensee (Spanish to English, vis versa). LPA explained the purpose of the inspection to Licensee. LPA, in the company of the Assistant, toured the exterior and interior of the FCCH. The FCCH's living room, kitchen, hall bathroom and day room and backyard are used for child care services, while remainder of the home is excluded from care. LPA notes the home in a single story dwelling with three bedrooms and three bathrooms. At the time of the inspection, LPA observed seven children present. LPA notes all children where in different phases of napping. The FCCH was clean and orderly and void of hazardous items. Required forms are posted in the FCCH's day room wall. Medication in the home is stored in the master bedroom which is excluded from care. Cleaning compounds are stored under the kitchen sink and in the garage, both of which are inaccessible to children. LPA observed the restroom used for children to be clean and free of toxins LPA observed a fireplace in the home which was screened and inaccessible to children in care. LPA observed smoke and carbon monoxide detectors in the FCCH. The aforementioned were not tested as children in care are in the process of napping. The FCCH has a regulation fire extinguisher which was serviced on 11/14/23. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. Toys, furniture and play equipment observed in the FCCH are age appropriate. The home maintains working telephone services. The backyard is enclosed by wooden fencing. The footing in the area is varied. LPA observed a shed in backyard which was secured. The shed contained household items. There is a secured side gate which (CONT' 809-C, Page 2)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

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: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 406214901
	VISIT DATE: 06/06/2024

NARRATIVE

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separates the area used for child care from the area used for personal effects. Toys and play equipment observed in backyard are safe, varied, age appropriate and in satisfactory condition. LPA observed no bodies of water on site. It should be noted Assistant informed LPA a Jacuzzi was removed from the backyard area about six months prior.

LPA reviewed children records. The children's records are current, complete and possessed emergency contact information, sleep checks, as well as immunization records, amongst other required licensing documents. LPA reviewed Licensee's records. Licensee's records are current and complete with CPR and First Aid certifications (EMSA Approved) expiring on 3/1/26 and a Mandated Reporter training certificate expiring on 9/15/25, amongst other required licensing documents. The FCCH has documentation noting fire drills. The last fire drill at the FCCH occurred on 6/6/24. The Licensee informed LPA no firearms or ammunition are stored on site.

THe Licensee does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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.

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 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.

Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or
(CONT. 809-C, Page 3)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

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: CERVANTES FAMILY CHILD CARE	FACILITY NUMBER: 406214901
	VISIT DATE: 06/06/2024

NARRATIVE

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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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 6/6/24.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Macrina Cervantes.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024

LIC809 (FAS) - (06/04)

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