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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215055
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:27:16 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:NUNEZ FAMILY CHILD CAREFACILITY NUMBER:
406215055
ADMINISTRATOR:MARGARITA NUNEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 927-5529
CITY:CAMBRIASTATE: CAZIP CODE:
93428
CAPACITY:14CENSUS: 4DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Margarita NunezTIME COMPLETED:
01:30 PM
NARRATIVE
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On 8/26/21, at 12:00 PM, Licensing Program Analyst (LPA) Elvin Baddley made an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Margarita Nunez, Licensee of the FCCH and explained the purpose of the inspection.It should be noted the FCCH's Assistant, Karely Nunez, assisted with communication between the LPA and the Licensee as the LIcensee is primarily Spanish speaking. The FCCH's living room, dining room, kitchen and hallway bathroom are used for child care, while the backyard, bedrooms and garage are excluded from child care services. LPA observed four children (two biologically related) on site at the time of the inspection, along with an Assistant, as mentioned..

LPA observed a fireplace in living room which was screened. The hallway bathroom used for children care was observed to be clean and free of toxins. Medication and sharps in the FCCH are observed in an elevated cabinet in the kitchen which is inaccessible to children in care. Detergents and cleaning compounds are in a locked cabinet underneath the kitchen sink. LPA observed carbon monoxide and smoke detectors in the FCCH. The aforementioned were tested (12:05 PM and 12:07 PM) and found to be operable. LPA observed a regulation fire extinguisher on site which was serviced on 6/22/21. LPA reminded Licensee to purchase or have fire extinguisher serviced annually.

As noted the FCCH's backyard is not used for care. The Licensee informed LPA children are taken to the neighborhood play areas. LPA reminded Licensee children should be directly supervised when completing activities at the aforementioned..

LPA reviewed a sampling of the children's records. Files reviewed contained no immunization records or emergency consent forms. At 12;40 PM, LPA reminded Licensee of the need to have the aforementioned in the files of children in care. LPA also reviewed the Licensee's records. LPA observed Licensee's Pediatric CPR and First Aid certifications which expire on 7/29/23. Licensee's Mandated Reporter training expires on 8/26/23. LPA observed two dog is on site. LPA reviewed the vaccination record for the dogs and found
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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 3
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: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 406215055
VISIT DATE: 08/26/2021
NARRATIVE
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the records current.

Licensee informed LPA no firearm or ammunition is stored on site.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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 discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it is Licensee's responsibility to know the regulations for a FCCH which can be accessed on-line at www.ccld.ca.gov.

Type B deficiencies are being cited based on LPA’s record reviews pursuant to Title 22 of the CA Code of Regulations (refer to LIC 809-D). Licensee was provided a copy of their appeal rights.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Licensee. A copy of this report was provided to the Licensee, whose signature is on this form confirms receipt of this document.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: NUNEZ FAMILY CHILD CARE
FACILITY NUMBER: 406215055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2021
Section Cited

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102417(g) (7) Operation of a Family Child Care Home - An emergency information card shall be maintained for each child and shall include the child's full name, telephone number and location of a parent or other responsible adult to be contacted in an emergency, the name...registrant to consent to emergency medical care
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This requirement was not met as evidenced by record review which revealed Child #1 had no completed emergency contact form on site

This poses a potential health, safety or personal rights risks to persons in care.
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Type B
08/27/2021
Section Cited

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102418 (a) Immunizations
Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000.
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This requirement was not met as evidenced by record review rwhich eveals Llicensee's not having Immunization records for Child #1 present.

This poses a potential health, safety or personal rights risks to persons in care.
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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: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021
LIC809 (FAS) - (06/04)
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