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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215128
Report Date: 04/23/2024
Date Signed: 04/23/2024 04:03:31 PM


Document Has Been Signed on 04/23/2024 04:03 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:HOLLOWAY FAMILY CHILD CAREFACILITY NUMBER:
406215128
ADMINISTRATOR:KIM DENISE HOLLOWAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 478-2515
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:14CENSUS: 11DATE:
04/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kim HollowayTIME COMPLETED:
04:15 PM
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On 4/23/25, at 1:45 PM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Random/Annual 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, 11 children are present, along with an Assistant (cleared and associated) providing care and supervision.

The home is orderly. There is not fireplace on site. The home does have ventilation to afford for the children’s comfort and safety. Medication is stored in a medicate cabinet in master bedroom which is excluded from care and inaccessible to children. LPA also observed cleaning compounds stored on elevated shelves in the converted garage and above the refrigerator in a cabinet in the kitchen which is outside the reach of children in care. Sharps in the kitchen area are stored in and elevated cabinet in the kitchen. LPA observed child safety gates at the base and top of the stairwell. A barricade fence is also in the entry to the kitchen and near the washer in the garage. There is also child safety gates around the hot water heater in the garage. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are predominantly posted on the wall in the converted garage. The FCCH has smoke and carbon monoxide detectors which were tested (3:32 PM and 3:33 PM) and found to be operable . LPA observed a regulation fire extinguisher in the FCCH which which was service on 1/9/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill log which notes the last drill occurred on 4/18/24. The FCCH maintains an operable telephone services.

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. LPA reminded Licensee to replace outdoor play equipment which begins to degrade or is not in good repair. No bodies of water are
(CONT. 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/23/2024
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: HOLLOWAY FAMILY CHILD CARE
FACILITY NUMBER: 406215128
VISIT DATE: 04/23/2024
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observed on site.

LPA reviewed the records of children on site. The records were current, complete and possessed emergency contact information and immunization records, among other things. Records also contained Sleep Plans for children and logs documenting the sleep of children (0-24 months) in 15 minute intervals. The Licensee's records are current and complete with pedantic CPR and First Aid certifications (EMSA approved) expiring on 5/2/25, and Mandated Reporter training certification expires on 4/12/25. The Licensee informed LPA no firearm or ammunition are stored on site.

Incidental Medical Services (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 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 4/5/24.
(CONT 809-C, Page 3)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
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: HOLLOWAY FAMILY CHILD CARE
FACILITY NUMBER: 406215128
VISIT DATE: 04/23/2024
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A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Kim Holloway.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024
LIC809 (FAS) - (06/04)
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