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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 406216030
Report Date: 09/17/2021
Date Signed: 09/17/2021 12:21:15 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:CAZARES FAMILY CHILD CAREFACILITY NUMBER:
406216030
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 3DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Rocio CazaresTIME COMPLETED:
12:25 PM
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On 9/17/2021 at 10:47am, Licensing Program Analyst (LPA) Melissa Stewart conducted a Facility Risk Assessment for COVID19 via phone with Licensee, Rocio Cazares. All answers indicated no exposure to COVID19. The purpose of the visit, Required 1 year inspection, was explained. Licensee wore a face covering. LPA observed the required documents posted inside of the home on the wall adjacent to the front door. There were two (2) were infants and one (1) preschool aged child. Child care services are provided in the living room and dining area located in the kitchen. LPA observed age appropriate toys, books, cots and portable cribs. LPA observed a Graco glider Reg # PA-24833 which has not been recalled by Consumer Product Safety Commission (CPSC). There are two bedrooms which are both kept locked during day care hours. There is a back door adjacent to the bathroom and there is a sliding lock at the top of the door. The bathroom used by children was observed to be clean and free of toxins. 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. Smoke and Carbon monoxide detectors were tested at 10:54am and found to be operational. LPA observed the 2 A10 BC fire extinguisher with a receipt of purchase date of 10/13/2020. Licensee was reminded to service or replace the fire extinguisher yearly. Licensee completes and documents emergency drills. The most recent drill was held on 7/9/2021.

Licensee reported that she takes the children outdoors to the garden area in the mobile park complex and that children are always supervised while outside. There is a pool which is completely fenced at the front entrance of the mobile home complex. Licensee stated that she does not take the children to the pool. Licensee reported that when she has an Assistant present, she takes the children to the park nearby.

Licensee has current Pediatric CPR and first aid expiring on 8/21/2022. Mandated Reporter Training per AB 1207 was completed on 8/30/2020. LPA reminded Licensee that the AB1207 training must be renewed every two (2) years. 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: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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: CAZARES FAMILY CHILD CARE
FACILITY NUMBER: 406216030
VISIT DATE: 09/17/2021
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 Facility roster and a sample of children's records were reviewed and found complete. Licensee is conducting and recording 15 minute checks of infants under two (2) years of age.

Infant Safe Sleep Regulation section 102425 was discussed. LPA provided PIN 20-24-CCP and Individual Infant Sleep Plan (LIC9227) in English and in Spanish. A sample Infant Sleep Log for 15 minute checks of all children under the age of two (2) years was also provided. LPA provided copies of the “Effects of Lead Exposure” brochure (PUB 515) in English and in Spanish (PUB515SP) and explained that the brochure must be given to each family at time of enrollment. LPA advised Licensee that Title 22, Division 12 regulations for Family Child Care Homes and California Department of Public Health COVID-19 guidelines for child care programs can be accessed on-line at www.cdss.ca.gov. COVID19 Information for San Luis Obispo County can be found at www.emergencyslo.org/en/covid19.aspx. Licensee stated that she is subscribed to receive Provider Information Notices (PINs) from Community Care Licensing Division via email.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she has an inhaler for one child (C1), but has never administered the medication. LPA observed that the medication is not expired and is labelled with the child's name (C1) and the box with the instructions for use. LPA explained that when any IMS is provided, a Plan for Providing IMS must be submitted to the Department. Licensee will submit the IMS plan which includes documentation for C1's medication to LPA on or before 9/30/2021. 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

In the areas evaluated today, no deficiencies were cited.

A copy of this report and appeal rights in English and Spanish were discussed and left with Licensee, Rocio Cazares whose signature on this form confirm receipt of these documents.

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

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
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