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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216020
Report Date: 09/11/2020
Date Signed: 09/14/2020 11:35:19 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:LOMELI FCC AKA CHUBBY BUNNY DAYCAREFACILITY NUMBER:
406216020
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
09/11/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
07:58 AM
MET WITH:Samantha LomeliTIME COMPLETED:
09:48 AM
NARRATIVE
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This is a change of location, previous facility number 406215878.

On September 11, 2020 7:56 A.M., Licensing Program Analyst (LPA) Francisca Velazquez conducted an announced change of location Pre-licensing inspection. Due to the COVID - 19 and Department of Public Health guidelines of social distancing, a tele-inspection was conducted. LPA conducted the tele-inspection via FaceTime and met with Applicant Samantha Lomeli. LPA discussed the nature and purpose of the inspection. During this tele-inspection the licensee took LPA on a tour of the facility. Licensee has a two story three bedroom home. There were no children in care at the time of the inspection.

The Applicant will be using two living rooms and one bathroom for the day-care area. Kitchen is off-limits by use of a gate, but children will access the kitchen as they walk through to get to the back yard with supervision of the applicant. The second story and garage will be off limits. LPA observed a secured gate on the bottom of the stairs preventing children from having access to the second floor. LPA observed day-care area to be clean and orderly with plenty of age appropriate activities and furniture. LPA observed a clean and toxin free bathroom for day-care children. LPA did not observe any toxins/hazardous items accessible to children. LPA observed a high safety latch on laundry room door making it inaccessible to children. Applicant stated that all cleaning and disinfecting chemicals are stored in the laundry room.

Cont.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406216020
VISIT DATE: 09/11/2020
NARRATIVE
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 A regulation 2A10BC fire extinguisher which was serviced on 09/04/2020 was observed mounted in the kitchen readily accessible. Applicant is reminded to service or purchase the fire extinguisher yearly. LPA observed Applicant test the smoke detector at 8:15 AM and carbon monoxide detector at 8:18 AM in the home and both were working appropriately. LPA observed that knives are stored in top cabinet not accessible to children.

LPA observed that backyard has fence that is incomplete. Applicant stated that children will not have access to backyard for about one month until the fence is secured and completed. LPA advised Applicant that she must have visual supervision of all children while the children are playing outside in the backyard. Applicant stated they do not have weapons and ammunition in the home.

Applicant’s Pediatric First Aid/CPR certificate is valid until 03/20/2021. Applicant provided copy of AB1207 that expires on 11/08/2021. Applicant provided a lease agreement to verify control of property. Applicant was provided and advised of safe sleep requirements and lead exposure guides.

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: http://www.ada.gov/childqanda.html

LPA provided Applicant with COVID-19 self-assessment and resources to be used in the facility.

CONT.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406216020
VISIT DATE: 09/11/2020
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LPA explained to Applicant that change in location application will be submitted to managers for final approval. Applicant understands that change in location application remains pending until final approval is granted. Applicant understands that LPA will communicate with her to inform of final approval once it is granted.

LPA explained to Applicant that this report will be emailed to her and requested it be sent back with signature of facility file.

Exit interview conducted with Licensee 09/11/2020. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing

On 09/14/2020, LPA communicated with Applicant to let her know that Licensing Program Manager (LPM) George Mingle and Regional Manager (RM) Adriana Hernandez approved change of location. LPA communicated with Applicant to let her know that her application has been granted and her change of location licensee will be effective tomorrow 09/15/2020. Applicant understands that she will receive an updated report via email for her to sign and send to us.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
LIC809 (FAS) - (06/04)
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