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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421710619
Report Date: 04/12/2023
Date Signed: 04/13/2023 09:37:09 AM


Document Has Been Signed on 04/13/2023 09:37 AM - 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:HOUSE FCC AKA DI'S HOUSEFACILITY NUMBER:
421710619
ADMINISTRATOR:DIANA HOUSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 733-3414
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 0DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Diana HouseTIME COMPLETED:
06:20 PM
NARRATIVE
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On 04/12/23 at 4:15 PM, Licensing Program Analysts (LPAs) Francisca Velazquez and Giovani Gonzalez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPAs met with Diana House, Licensee of the FCCH and explained the purpose of the inspection. LPAs notes COVID Pre-screening questions were asked of Licensee prior to the inspection. The Licensee's responses suggest the FCCH is void of COVID positive cases. At the time of the inspection, there were no children present due to families being on spring break. There are two (2) adults that live in the home and one (1) adult has fingerprint clearance.

LPAs, in the company of Licensee toured the interior and exterior of the FCCH. This home is a single-story home consisting of formal living room, dining room, kitchen, computer room, three (3) bedrooms, one (1) bathroom, laundry room, detached garage, and outdoor yard. The FCCH’s living room, dining area, computer room, two (2) bedrooms, one (1) bathroom and part of the outdoor yard are accessible for childcare services. Meanwhile, one (1) bedroom, detached garage, laundry room and part of the outdoor yard are off-limits to children in care. Per licensee, children go through the laundry room to get to the outdoor yard and are always accompanied by licensee.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. LPAs observed sharps and medication are stored in an elevated cabinet in the kitchen. LPAs observed cleaning compounds are stored in an elevated closet in the hallway of the FCCH. The bathroom used for childcare is clean and free of toxins. LPA observed toys, furniture, and equipment in the FCCH are age appropriate and in good condition. LPAs notes there are plenty of activities for children indoors and outdoors.

Required forms are predominantly posted in the kitchen area of the FCCH. LPAs observed a smoke and carbon monoxide detectors in the FCCH. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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: HOUSE FCC AKA DI'S HOUSE
FACILITY NUMBER: 421710619
VISIT DATE: 04/12/2023
NARRATIVE
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Detectors were tested at 4:45 PM and were found to be operable. The FCCH has a regulation fire extinguisher on site which was serviced on 01/23/2023. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services. The Licensee informed LPAs no firearms or ammunition are stored on site.

LPAs and Licensee toured the outdoor yard. LPAs notes that children only have access to part of the outdoor yard. Yards are separated by means of fence. LPAs observed children yard has plenty of shading to afford the children in care. Children have access to filtered water by means of individual cups. LPAs observed there are plenty of toys, furniture and equipment that is age appropriate and in good conditions.

LPAs reviewed children's records. The records are current, complete, and possessed emergency contact information and immunization records. LPAs did not review 15-minute checks for infants as there are no infants enrolled in the FCCH. A review of the FCCH's fire drill log shows the last drill occurred 11/8/22. The Licensee's records were reviewed. Licensee’s pediatric CPR and First Aid certification expires on 01/15/24. Licensee does not have Mandated Reporter training certificate and agrees to complete the training and submit proof of certificate.

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

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep

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

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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: HOUSE FCC AKA DI'S HOUSE
FACILITY NUMBER: 421710619
VISIT DATE: 04/12/2023
NARRATIVE
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 as an for additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Today, deficiency cited under Title 22 Division 12, civil penalty is access, appeal rights given. Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Diana House.

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

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/13/2023 09:37 AM - It Cannot Be Edited

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: HOUSE FCC AKA DI'S HOUSE
FACILITY NUMBER: 421710619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in that there is an adult living in the home that has not been fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/13/2023
Plan of Correction
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Licensee agrees to ensure that uncleared adult gets fingerprinted and will ensure that the adult receives clearance. Adult will go immediately to get fingerprinted.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 04/13/2023 09:37 AM - It Cannot Be Edited

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: HOUSE FCC AKA DI'S HOUSE
FACILITY NUMBER: 421710619

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that licensee does not have Mandated Reproter training certificate which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2023
Plan of Correction
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Licensee agrees to complete Mandated Reporter training certificatre and submit proof via email to francisca.velazquez@dss.ca.gov by 4/19/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
LIC809 (FAS) - (06/04)
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