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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215795
Report Date: 06/20/2019
Date Signed: 06/23/2019 06:41:24 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:ROJAS FAMILY CHILD CAREFACILITY NUMBER:
406215795
ADMINISTRATOR:ALCANTAR ROJAS&ROJAS ESTRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 994-9291
CITY:ARROYO GRANDESTATE: CAZIP CODE:
93420
CAPACITY:14CENSUS: 2DATE:
06/20/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Cinthya Rojas and Diana RojasTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Gigi Reyes conducted an announced Pre Licensing inspection and met with applicants, Ms. Cinthya Rojas and Ms. Diana Rojas. Ms. Cinthya Rojas' 2 children were present. The home is located in a compound of 3 houses. The home was toured inside and out. The front and back yards of the compound have fence but the compound has no gate. A complete visual supervision will be rendered when day care children are doing outdoor activities. Living room is dedicated for day care children. Garage and 3 bedrooms are not accessible to day care children, segregated with a gate.

Applicant stated there are no guns nor ammunition in the home. LPA did not observe any bodies of water. It was observed that home is clean and free of toxins. Cleaning compound, hazardous items are stored inaccessible to day care children. CPR and First Aid expires on 4/27/2021. Preventive Health Training was completed on 4/13/2019. AB 1207 was taken on 5/2/2019. Applicants have complete record of immunization and have met the SB 792. LPA discussed the Safe Sleep Concept and the "Effects of Lead Exposure" and provided flyer for distribution to day care children.

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:
continued on 809 C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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: ROJAS FAMILY CHILD CARE
FACILITY NUMBER: 406215795
VISIT DATE: 06/20/2019
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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

The applicants initially applied for a Large Family Child Care Home (FCCH) but decided to apply for a Small FCCH. Applicants were advised that the difference on the application fee is not refundable.

Home is pending approval for LIC 508 Criminal Record Statement Clearance for Diana and LIC 9149 Property Owner/Landlord Consent Form.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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