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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406215943
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:34:29 PM


Document Has Been Signed on 05/18/2022 12:34 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:PEREZ FCC AKA MAYA'S CAREFACILITY NUMBER:
406215943
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
05/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angelica PerezTIME COMPLETED:
12:45 PM
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 05/18/2022 at 9:15 A.M. Licensing Program Analyst (LPA), Martina Jimenez, conducted an unannounced Annual Required Inspection and met with Angelica Perez, Licensee, and Natalia Hernandez Perez, licensee's daughter/assistant. . The purpose of the inspection was explained, and together the home was toured inside and out. All required forms are posted in a prominent location. LPA observed 1 infant and 6 children in care at the time of the inspection.

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 4 bedroom, 1 bathroom, and garage are secured with safety locks and door knob covers, making them off limits to day care children. All hazardous items are stored inaccessible to children in care. LPA observed playhouses, play structures, and slide, tables and chair age appropriate for children. The backyard is completely fenced. LPA observed a small dog and a large dog secure inaccessible to day-care children.

No bodies of water were observed. Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. The fire extinguisher was observed at 9:50 AM to have been serviced on 06/17/2021. Licensee was reminded to service or replace the fire extinguisher yearly.

There is a functioning carbon monoxide detector and smoke alarm were tested at 10:04AM in the home, that meets statutory requirements at the time of the inspection.

Licensee is current with immunization required per SB 792. The last Safety drill was conducted 5/18/2022. Continued on LIC 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
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: 05/18/2022
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Licensee is current with CPR and First Aid which expires 01/29/2024. The Mandated Reporter Training was completed on 6/10/2020. Facility roster and a sample of children's records were reviewed at 11:08 AM and founded to be complete.

On 4/01/22, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The San Luis Obispo Fire Department granted a fire clearance following an inspection conducted on FCCH on 05/13/2022.



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 (PIN 20-24-CCP), "What is Carbon Monoxide?". LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided online at www.ccld.ca.gov.

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.

The home meets requirements for a large Family Childcare license. The license will be effective today, May 18, 2022.

The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez. In the areas evaluated, no deficiency were cited. LPA observed licensee post the Notice of Site visit FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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