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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215517
Report Date: 05/17/2019
Date Signed: 05/24/2019 12:06:33 PM

COMPREHENSIVE INSPECTION
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:COLLINS FCC AKA ABC CHILDCAREFACILITY NUMBER:
406215517
ADMINISTRATOR:MELINDA COLLINSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 547-4557
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:14CENSUS: 10DATE:
05/17/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:Melinda CollinsTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced annual/random and met with Licensee, Melinda Collins. 10 children were present when LPA arrived. Licensee was by herself, she stated that her assistant was at her lunch break. The home was toured inside and out.

Licensee and assistant have record of immunization that met the SB 792 requirements. Licensee conducts and documents fire and disaster drill every 6 months. Last drill was conducted on 12/23/2018. LPA observed that cleaning materials, pesticide, bleach are stored in a kitchen cabinet accessible to children in care. LPA reviewed children's file and observed that licensee did not maintain and update the immunization record of Child #1 . Review of facility file revealed that licensee and assistant have not taken the AB1207 Mandated Reporter Training. Licensee stated that fire extinguisher has not been serviced for a year. Date of purchase in the receipt is not legible. The facility has no children's roster.

The home does not provide 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.

Continued on 809 C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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 5
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: COLLINS FCC AKA ABC CHILDCARE
FACILITY NUMBER: 406215517
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/27/2019
Section Cited
CCR
102418(g)/(g)(1)
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(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.
(1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
This requirement is not met as evidenced by
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Licencee agreed to submit a plan of correction to CCLD no later that 5/27/2019 on how ensure that each day care child's PM286 is maintained and updated.
gigi.reyes@dss.ca.gov
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Based on LPA's review of children's record, Child # 1's Immunization card (PM286) is blank. Licensee did not update the immunization record.
This poses a potential risk to health and safety of children in care.
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Type B
05/27/2019
Section Cited
HSC
1596.8662(b)(1)
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(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility... shall complete the mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement is not met as evidenced by:
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Licensee and staff agreed to submit AB1207 Mandated Reporter Training Certificates on May 27, 2019. gigi.reyes@dss.ca.gov
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Based on LPA's review of facility record Licensee and Staff have not taken the AB 1207 Mandated Reporter Training. This poses a potential risk to health and safety of children 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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: COLLINS FCC AKA ABC CHILDCARE
FACILITY NUMBER: 406215517
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/20/2019
Section Cited
CCR
102416.5(e)
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(e) If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c)

This requirement is not met as evidenced by:
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Licensee agreed to submit a plan of correction no later 5/20/2019 on how to ensure that family child care home stays within staffing ratio and capacity at all times. Assistant arrived in the facility after an hour.
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Based on LPA's observation during the inspection, there were 10 children present without the assistant. Licensee stated that assistant was taking her lunch. This poses an immediate risk to health and safety of children in care.
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Type A
05/17/2019
Section Cited
CCR
102417(g)(4)
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 The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to
(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
This requirement is not met as evidenced by:
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Licensee agreed to fix the lock and move the cleaning materials inaccessible to children and licensee will submit a written plan of correction to ensure that poisons, detergents cleaning compounds are stored inaccesible to children.
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Based on LPA's observation during the inspection, pesticides and bleach were stored in an unlocked kitchen cabinet. Licensee said there was a magnetic lock but it broke.

This poses an immediate risk to health and safety to children 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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: COLLINS FCC AKA ABC CHILDCARE
FACILITY NUMBER: 406215517
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2019
Section Cited
CCR
1202417(g)(1)
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The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.



This requirement is not met as evidenced by:
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Licensee agreed to submit a plan of correction to CCLD on how to ensure that fire extinguisher is serviced annualy. Licensee have schuduled the service on June 5, 2019.
gigi.reyes@dss.ca.gov
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Based on LPa's observation and interview with licensee, licensee stated that Fire extinguisherr has not been serviced for a year and licensee already scheduled its service. This poses a potential risk to health and safety of children in care
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Type B
05/27/2019
Section Cited
CCR
102417(g)(8)
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Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.




This requirement is not met as evidenced by:
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Licensee agreed to complete and submit a children's roster to CCLD no later than 5/27/2019. gigi.reyes@dss.ca.gov
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Based on LPA's review of facility record, it was observed that home does not have a current roster of children. Licensee stated LIC 9040 - Roster was not in the packet given to her during the prelicensing. This poses a potential risk to health and safety of children 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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: COLLINS FCC AKA ABC CHILDCARE
FACILITY NUMBER: 406215517
VISIT DATE: 05/17/2019
NARRATIVE
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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

In the areas evaluated, deficiencies were cited under Title 22 Division 12 of California Code of Regulation and Health and Safety Code (809 D)



Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

Upon receipt of the report, provide copies of this licensing report to each parent/guardian of enrolled children and to parents/guardians of newly enrolled children during the next 12 months. Acknowledgement of Receipt LIC 9224 form shall be used for this purpose. LIC 9224 after completed shall be maintained in each child's file. (LIC 9224 was provided to the Center.)

Appeal Rights given.



LPA observed Licensee posted Notice of Site Visit
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5