406215128-7-8-2021-17-CC-EBAY-C4QVNN-20210708163514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215128
Report Date: 07/08/2021
Date Signed: 07/08/2021 04:35:47 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:	HOLLOWAY FAMILY CHILD CARE		FACILITY NUMBER:	406215128
ADMINISTRATOR:	KIM DENISE HOLLOWAY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 478-2515
CITY:	ARROYO GRANDE	STATE: CA	ZIP CODE:	93420
CAPACITY:	14	CENSUS: 8	DATE:	07/08/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kim Halloway		TIME COMPLETED:	11:05 AM

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 7/8/21, at 9:30 AM Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Kim Halloway, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The FCCH’s living room, dining room, backyard, converted garage and upstairs restroom are used for childcare services, while the home’s bedrooms are excluded from child care. At the time of the inspection eight children are present, along with an assistant. Required forms are predominantly posted on the wall in the converted garage. The FCCH has no fireplace, however a water heater in the converted garage is barricade by custom fencing. The FCCH has smoke and carbon monoxide detectors which were tested (10:01 AM and 10:02 AM) and found to be operable . LPA observed a regulation fire extinguisher in the FCCH which which was service on 1/27/21. 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/disaster drill occurring on 5/18/21. The FCCH maintains an operable telephone services. The home had ventilation to afford for the children’s comfort and safety. Further, the home is void of hazardous items. Medication is stored in a medicate cabinet in master bedroom which inaccessible to children in care. LPA also observed cleaning compounds stored on elevated shelves in the converted garage and above the refrigerator in a cabinet which is outside the reach of children in care. Sharps in the kitchen area are stored atop the refrigerator. LPA observed child safety gates at the base and top of the stairwell. Toys, furniture and equipment observed in the FCCH are age appropriate. The backyard is enclosed by a wooden fence. The fence’s entry/exit gates are secure. Toys and play equipment observed in backyard are age appropriate and in satisfactory condition. No bodies of water are observed on site. (CONT 809-C)

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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: HOLLOWAY FAMILY CHILD CARE	FACILITY NUMBER: 406215128
	VISIT DATE: 07/08/2021

NARRATIVE

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A sampling of the children records were reviewed. The children Records are complete and current. The Licensee’s records are also current and complete with Pediatric CPR and First Aid certifications expiring on 6/10/23, and Mandated Reporter Training expiring 7/8/23.

The Licensee stated no firearms or ammunition is on stored on site.

The Licensee is not providing 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 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.

In areas evaluated, there were no deficiencies cited at this time.

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 Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC809 (FAS) - (06/04)

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