406215943-6-17-2021-17-CC-EBAY-C43NAJ-20210617101736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215943
Report Date: 06/10/2021
Date Signed: 06/17/2021 10:18:15 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:	PEREZ FCC AKA MAYA'S CARE		FACILITY NUMBER:	406215943
ADMINISTRATOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	8	CENSUS: 3	DATE:	06/10/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Angelica Perez		TIME COMPLETED:	03:45 PM

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 6/10/21, Licensing Program Analyst (LPA) Elvin Baddley and LPA Francisca Velazquez conducted an unannounced Required Inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Angelica Perez, Licensee of the FCCH and explained the purpose of the inspection. LPAs, in the company of Licensee, toured the interior and exterior of the FCCH. The home’s living room, guest bedroom, backyard and hallway restroom are used for child care services, while the home’s remaining bedrooms (2), laundry room and garage are excluded from child care. At the time of the inspection, 3 children (1 related) are present. Required forms are predominantly posted on the walls of the living room. The FCCH has a fireplace which in screen glass and inaccessible to children in care. LPAs observed smoke and carbon monoxide detectors in the FCCH. Detectors were each tested (3:33 PM and 3:34 PM) and found to be operable. Likewise, the home has a regulation fire extinguisher which was serviced on 6/15/20. LPAs reminded the Licensee of the fire extinguisher's looming expiration date and the need to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services. The FCCH is void of hazardous items. Additionally, the FCCH is orderly, clean and had ventilation to afford for child care services. Medication in the FCCH is stored the master bedroom and on an elevated shelf in a kitchen cabinet. Each location is inaccessible to children. LPAs also observed cleaning compounds in a hall way closet and on an elevated shelf in the home's laundry room cabinet. As previously noted each, location is inaccessible to children in care. Toys and equipment observed in the FCCH are age appropriate. The FCCH backyard is partitioned by wired fencing and a chain linked gate. Plants and bush with pointed vegetation is enclosed by the wired fencing. The area contains age appropriate games, toys and furnishing and is free of hazard. No bodies of water were observed on site. A sampling of the children records were reviewed. The records were current, complete and possessed emergency contact information as mandated by regulations. The Licensee's records indicate Mandated (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: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

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: PEREZ FCC AKA MAYA'S CARE	FACILITY NUMBER: 406215943
	VISIT DATE: 06/10/2021

NARRATIVE

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Reporter training was completed 6/10/20, and CPR and First Aid certifications expired on 2/29/22. The FCCH has two dogs on site. LPAs review vaccination records for each dog and found records to be current.

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

LPAs discussed COVID 19 guidance and best practices with the Licensee. Licensee was reminded that it iis Licensee responsibility to know the regulations for Family Child Care Home which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, no deficiencies observed.

Report was read to Licensee in Spanish by LPA Velazquez as Licensee is primarily Spanish speaking. LPAs provided

Licensee with Notice of Site visit (LIC 9213) which was posted by the Licensee.

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SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2021

LIC809 (FAS) - (06/04)

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