421711005-4-13-2023-17-CC-FVEZ-CQUMFQ-20230413093442

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421711005
Report Date: 04/12/2023
Date Signed: 04/13/2023 09:34:52 AM

Document Has Been Signed on 04/13/2023 09:34 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:	PICO FCC AKA DORIS FAMILY CARE		FACILITY NUMBER:	421711005
ADMINISTRATOR:	PICO, DORIS		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 451-2302
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 6	DATE:	04/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Doris Pico		TIME COMPLETED:	03:30 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 04/12/23 at 12:45 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 Doris Pico, 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, LPAs observed six (6) children on site during inspection. There is one (1) adult that live in the home and 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 three (3) bedrooms, two (2) bathroom, living room, dining room, kitchen, garage, and outdoor yard. The FCCH’s living room, dining area, kitchen, one (1) bedroom, one (1) bathroom, garage and outdoor yard are accessible for childcare services. Per licensee, the garage has been used since licensee was licensed in 1990. Meanwhile, two (2) bedrooms, one (1) bathroom and part of the outdoor yard are inaccessible to children in care. The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. LPAs observed the living room and garage is where most of the daycare services occur. LPAs observed sharps are stored in an elevated cabinet in the kitchen. Per licensee, there is no medication in the home. LPAs observed cleaning compounds are stored in an elevated cabinet in the kitchen which are inacessible to children in care. The bathroom used for childcare is clean and free of toxins. LPAs 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 garage of the FCCH. LPAs observed a combination smoke and carbon monoxide detector in the FCCH that was tested and operable at 1:12 PM. CONT 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (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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Document Has Been Signed on 04/13/2023 09:34 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: PICO FCC AKA DORIS FAMILY CARE	FACILITY NUMBER: 421711005
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102417(g)(1)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that fire extinguisher expired on 3/4/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee agrees to service her fire extinguisher and submit proof via email at francisca.velazquez@dss.ca.gov by 4/19/23.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (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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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: PICO FCC AKA DORIS FAMILY CARE	FACILITY NUMBER: 421711005
	VISIT DATE: 04/12/2023

NARRATIVE

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The FCCH has a regulation fire extinguisher on site which was serviced on 03/04/2021. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. During inspection, licensee contacted fire department to make an appointment to service her extinguisher. The FCCH maintains working telephone services. The Licensee informed LPAs no firearms or ammunition are stored on site.

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 water cups. LPAs observed there are plenty of toys, furniture and equipment that is age appropriate and in good conditions. LPAs observed there are no bodies of water on site.

LPAs reviewed children's records. The records contained emergency cards and immunization records. Licensee is not documenting 15 minute infant sleep checks, as she was not aware of the new regulations. Licensee agrees to start documenting infant sleep moving forward. A review of the FCCH's fire drill log shows the last drill occurred on 3/15/23 . The Licensee's records were reviewed. Licensee’s pediatric CPR and First Aid certification expires on 7/28/20. Licensee stated that she renewed her card but can not find it. Licensee has attempted to contact instructor but has not received a call back. Licensee agrees to send LPAs a copy of current CPR/First-aid or agrees to retake it if needed. Licensee can not find Mandated Reporter training certificate. Licensee stated taking this training and will send LPA copy of current certificate or will retake the course if the certificate has expired.

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.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (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: PICO FCC AKA DORIS FAMILY CARE	FACILITY NUMBER: 421711005
	VISIT DATE: 04/12/2023

NARRATIVE

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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 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.

During today's inspection, Type B deficiency is being cited.

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

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca Velazquez	TELEPHONE: (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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