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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216020
Report Date: 02/25/2021
Date Signed: 02/25/2021 04:49:35 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:LOMELI FCC AKA CHUBBY BUNNY DAYCAREFACILITY NUMBER:
406216020
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
02/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:08 PM
MET WITH:Samantha LomeliTIME COMPLETED:
04:50 PM
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On 2/25/2021 at 3:08pm, Licensing Program Analyst (LPA) Melissa Stewart conducted an unannounced Case Management inspection with Licensee, Samantha Lomeli in response to Licensee's request to increase capacity from a small Family Child Care (FCC) home to a large FCC. Due to COVID-19 and Department of Public Health guidelines of physical distancing, the inspection of the home (inside and outside) was conducted via Face Time. LPA observed four (4) children sleeping on cots and one (1) infant sleeping in the main play area at the time of inspection. Outside of the home, Licensee has required posters regarding COVID19 and a coat rack for children's backpacks. Licensee reported that children do not bring blankets or toys into the home. Licensee stated that daily health screenings including a temperature check of each child are conducted at the front door prior to children entering the home. Licensee reported that most of the parents wear face coverings at drop off, but sometimes forget. LPA advised that Licensee remind parents that it is important to wear a face covering for their own protection and that of the Licensee. Children over the age of two are required to wear a face coverings when they enter the home.

LPA observed required licensing documents posted inside the home on the wall. The 2 A10 BC Fire Extinguisher is located in the pantry in the kitchen and was serviced on 9/4/2020. The smoke and carbon monoxide detectors were not tested today since the children were sleeping. Licensee reported that the Paso Robles Fire Department tested the detectors during their inspection on 2/19/21; fire clearance was granted.

LPA observed a child sized table and chairs along with books and toys in the second, smaller indoor activity area. There is a security gate at the foot of the stairs. The upstairs is completely off limits to children in care. Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021
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: LOMELI FCC AKA CHUBBY BUNNY DAYCARE
FACILITY NUMBER: 406216020
VISIT DATE: 02/25/2021
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The restroom used by children was observed to be clean and free of toxins. There is a door to the garage and to the laundry room which both have latches toward the top of the door.

There is a safety gate between the hallway and the kitchen and living room area. There are two high chairs in the kitchen. Licensee stores cleaning supplies in laundry room and knives are stored out of reach. There are couches in the living room and children sometimes sit on the carpet while Licensee is cooking in the kitchen. Licensee stated that there are no guns or ammunition stored in the home.

The back yard is completely fenced with two gates on either side of the house. Licensee reported that her dog is kept in the kennel when children are playing outdoors and that the dog has a license and vaccinations are up to date. LPA observed a small slide, tunnel, small climber and swing set on grass. LPA advised that she would email the playground safety handbook to Licensee and discussed play area surfacing. There is a small gate with latch that leads to the emergency exit gate on the side of the house. On the opposite side of the house there is another gate which is kept locked.

Licensee has a current Pediatric CPR/first aid certification which expires on 3/20/2021. Licensee reported that she has an appointment to renew her certification on Friday, 2/26/21. Mandated Reporter Training for Child Care Providers is due to be renewed by 11/8/2021. Licensee stated that she does not currently have liability insurance and that she provides the Affidavit Regarding Liability Insurance (LIC 282) to parents at time of enrollment.

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.htm

Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 02/25/2021
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Licensee indicated that she is familiar with the required forms for a Family Child Care Home (LIC 311D) including the Effects of Lead Exposure brochure (PUB 515) which is to be distributed to all families at time of enrollment or upon re-enrollment. Infant Safe Sleep regulations were discussed.

The home meets Title 22, Division 12 requirements of a Large Family Child Care home. License is effective today, 2/25/2021.

The FaceTime call was concluded at 3:31pm. LPA called Licensee back at 4:33pm and an exit interview was conducted. LPA reviewed the report and the following information with Licensee:

  • Appeal Rights
  • Regularly review Consumer Product Safety Commission product recalls at www.cpsc.gov and read and abide by the manufacturer’s directions which specify the age recommendations for toys and furnishings used by children.
  • Title 22, Division 12 regulations for Family Child Care Home can be accessed on-line at www.cdss.ca.gov. Licensee reported that she receives Provider Information Notices (PINs) from Community Care Licensing Division via email.

This report along with a copy of the appeal rights and Notice of Site Visit (LIC 9123) will be sent to Licensee via email today. Licensee voiced understanding that in lieu of signature an email reply is required within 24 hours to confirm receipt of the report and appeal rights.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K StewartTELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2021
LIC809 (FAS) - (06/04)
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