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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215517
Report Date: 12/19/2019
Date Signed: 12/19/2019 10:56:18 AM

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: 11DATE:
12/19/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:TIME COMPLETED:
11:05 AM
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(1) Licensing Program Analyst (LPA), Martina Jimenez, conducted an unannounced annual/required inspection and met with Licensee, Melinda Collins, Casandra Miller-Bohard, Assist, Matthew Collins, Licensee’s husband, and Hunter Collins, licensee’s son. The purpose of the inspection was explained, and the home was toured inside and out. All required forms are posted in a prominent location. At the time of inspection, LPA observed 11 children playing in the living room and main day care room.

The main day-care areas are the living room, day-care room, dining room, kitchen and bathroom. LPA observed age appropriate toys and books in the indoor activity area. The bathroom used by children was observed to be clean and free of toxins. The bedroom and upstairs is off limits to day care children. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. LPA observed playhouses, play kitchen and small climbing structures, tricycles, tables and chair age appropriate for children. The backyard is completely fenced. No bodies of water were observed during the visit.

THIS REPORT CONTINUES ON LIC809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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: COLLINS FCC AKA ABC CHILDCARE
FACILITY NUMBER: 406215517
VISIT DATE: 12/19/2019
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Carbon monoxide and smoke detectors were tested and operational. LPA observed the 2 A10 BC fire extinguisher which was purchased on 05/17/19. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee emergency drills completed and documented was 10/15/2019. Licensee is CPR and first aid certified through 8/17/21. Licensee has met SB 792 immunization requirement and completed AB1207 Mandated Reporter Training on 05/27/19. Facility roster and a sample of children's records were reviewed and found complete.

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 reviewed and provided Licensee with Safe to Sleep brochure. LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.
In the areas evaluated, no deficiency cited. LPA observed Licensee post the Notice of Site visit.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
LIC809 (FAS) - (06/04)
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