406216020-8-12-2021-17-CC-MKST-C5TTJB-20210812144605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406216020
Report Date: 08/12/2021
Date Signed: 08/12/2021 02:46:10 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 DAYCARE		FACILITY NUMBER:	406216020
ADMINISTRATOR:	SAMANTHA LOMELI		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 434-8703
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	14	CENSUS: 9	DATE:	08/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Samantha Lomeli		TIME COMPLETED:	02:50 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 8/12/21 at 1:17pm, Licensing Program Analyst (LPA) Melissa Stewart arrived and attempted to conduct a Facility Risk Assessment for COVID19 via phone. The call was not answered, so LPA proceeded to the door and met with Licensee, Samantha Lomeli. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee and Assistant were wearing face coverings. LPA observed the required documents posted inside the home on the wall adjacent to the front door. There were four (4) children napping on cots in the front room to the left as you enter the home. LPA observed age appropriate toys, books and child sized table and chairs in the indoor activity areas. There is a retractable safety gate at the foot of the stairs. Licensee reported that the upstairs (3 bed/2 bath) are off-limits to day care children. The downstairs bathroom used by children was observed to be clean and free of toxins. There are two doors which lead to the garage that are kept locked with a sliding latch at the top of the door. There is an open plan kitchen with additional activity area that includes couches, small table and a TV. LPA observed two (2) children napping and three (3) children playing in this area which has a screened fireplace. The three (3) children who were awake were not wearing face coverings. LPA explained the current guidance requiring face coverings in child care settings. Detergents, cleaning compounds, medications and other items such as kitchen knives which could pose a danger to children are stored inaccessible to children. Licensee stated there are no guns or ammunition in the home. Carbon monoxide detector located in the kitchen was tested at 1:24pm and found to be operational. LPA observed the smoke detector in the hall, but did not request that it be tested since the children were napping. LPA observed the 2 A10 BC fire extinguisher with a service date of 9/4/2020. Licensee was reminded to service or replace the fire extinguisher yearly and retain the receipt for review during inspections. Licensee completes and documents emergency drills. The most recent drill was held on 6/2/21. The backyard is accessed through the sliding glass door. LPA observed a blow up pool filled with water. Licensee stated that she keeps the pool full for two days and then empties the pool to be re-filled with clean water. Licensee stated that children are always supervised outdoors. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

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: 08/12/2021

NARRATIVE

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The backyard is completely fenced; LPA observed age appropriate riding toys, playhouse and shaded cement patio area. There is a dog in a kennel outdoors; Licensee stated that she has current license on file.
Licensee is Pediatric CPR and first aid certified through 2/26/2023. Licensee and Assistant have met SB 792 immunization requirement and have proof of negative TB on file. Licensee completed Mandated Reporter Training per AB 1207 on 11/8/2019. LPA reminded Licensee that the Mandated Reporter training must be renewed every two years (11/8/2021). Facility roster and a sample of children's records were reviewed and found complete. Licensee was reminded that it is her responsibility to know the regulations for FCCH which can be accessed on-line at www.cdss.ca.gov. Licensee reported that she receives Provider Information Notices (PINs) via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that there are no children enrolled who require medications at this time. 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

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided a copy of the Individual Infant Sleeping Plan (LIC 9227) and sample Infant Sleep Log for 15 minute checks of all children under the age of two years. LPA also provided Licensee with a copy of the Lead Exposure brochure in English and Spanish to be given to all families at time of enrollment or re-enrollment.

A copy of this report and appeal rights were discussed and left with Licensee, Samantha Lomeli, whose signature on this form confirm receipt of these documents.

In the areas evaluated today, no deficiencies were cited.

LPA provided a Notice of Site Visit (LIC 9213) to be posted. FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021

LIC809 (FAS) - (06/04)

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