421712407-6-27-2022-17-CC-GRES-CFT2AF-20220627171324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421712407
Report Date: 06/27/2022
Date Signed: 06/27/2022 05:13:46 PM

Document Has Been Signed on 06/27/2022 05:13 PM - 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:	CARPENTER FAMILY CHILD CARE		FACILITY NUMBER:	421712407
ADMINISTRATOR:	CARPENTER, JULIA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 733-2204
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 17	DATE:	06/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Julia Carpenter		TIME COMPLETED:	05:15 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 June 27, 2022 at 12:40 PM, Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required Inspection. LPA asked pre screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID 19 exposures on site. When LPA knocked on the door, Child # 14 opened the door, 3 to 5 minutes later, Staff 2 came to the door. Staff 2 called the Licensee and the latter let the LPA into the FCCH. LPA met with licensee, Ms. Julia Carpenter and discussed the purpose of the inspection. LPA interviewed Child # 14 who stated Staff 2 was in the backyard when Child # 14 opened the door. Staff 2 stated staff and the rest of children were transitioning from outside to the inside day care. Licensee stated she was in the nap room when LPA arrived. LPA in the company of Licensee toured the interior and exterior of the day care. LPA observed 13 children were in the backyard playing and 4 other children were in the nap room. Licensee stated, her assistant, Staff 2 had to take own children (Child # 16 and Child # 17) to the day care due to a family emergency. When Staff 3 came back from lunch, Staff 2 brought home C16 and C17. The licensee uses the converted garage, one room on the lower level of the home for the day care and the backyard. The Licensee uses the kitchen on the upper level for eating only. The staircase is barricaded. There are age appropriate toys and furnishings. LPA observed required licensing forms are posted in the FCCH. LPA observed smoke and carbon monoxide detectors in the FCCH. The regulation fire extinguisher was serviced on 5/6/2022. Home conducts and documents fire and disaster drill every month, last drill was conducted on 6/17/2022. The play yard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

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: CARPENTER FAMILY CHILD CARE	FACILITY NUMBER: 421712407
	VISIT DATE: 06/27/2022

NARRATIVE

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LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 1/23/2023. Licensee and Staff 4 did not take the Mandated Reporter Training per AB 1207. Staff 2 and Staff 4 have no immunization record on file,
FCCH has current roster of children in care. A sampling of children records were reviewed. Child # 11, Child 15, Child # 16 and Child # 17 do not have records on file for review.

During today's inspection, deficiencies were cited under Title 22 Division 12 of California Code of Regulation and Health and Safety Code,

LPA Reyes informed licensee Ms. Carpenter that this report dated 6/27/2022 documents two (2) Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.
Also, LPA Reyes informed the licensee, Ms. Carpenter to provide a copy of this licensing report dated 6/27/2022 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

Cont on LIC 809 C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

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: CARPENTER FAMILY CHILD CARE	FACILITY NUMBER: 421712407
	VISIT DATE: 06/27/2022

NARRATIVE

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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 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
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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Ms. Julia Carpernter.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/27/2022 05:13 PM - 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: CARPENTER FAMILY CHILD CARE	FACILITY NUMBER: 421712407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102416.5(a)

Staffing Ratio and Capacity

(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at any one time. 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, LPA observed 17 day care children at the time of the inspection which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/27/2022
	Plan of Correction
1 2 3 4	Licensee corrected the deficiency during the inspection. At 1:05PM when Staff 3 came back from lucnh Staff 2 brought home C16 and C17. At 1:09 PM Authorized representative picked up C6. Licensee agreed to submit a written plan of correciton to ensure that daycare capacity requirment will be maintained.

Type A

Section Cited

CCR

102423(a)(2)

Personal Rights

(a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following: (2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment. 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, when LPA arrived Child # 14 answered the door which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/28/2022
	Plan of Correction
1 2 3 4	Licensee agreed to submit a plan of correction to CCL no later than 6/27/2022.

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: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/27/2022 05:13 PM - 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: CARPENTER FAMILY CHILD CARE	FACILITY NUMBER: 421712407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2022

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above Licensee and Staff 4 did not take/renew the Mandated Reporter training per AB 1207 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Licensee agreed to take the Mandated Reporter Training and submit proof of correction to CCL no later than 7/7/2022.

Type B

Section Cited

HSC

1597.622(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review , the licensee did not comply with the section cited above, Staff 2 and Staff 4 do not have immunization record which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Licensee agreed to submit the proof of required immunization of Staff 2 and Staff 4 to CCL no later than 7/7/2022.

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: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

Page: 5 of 6

Document Has Been Signed on 06/27/2022 05:13 PM - 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: CARPENTER FAMILY CHILD CARE	FACILITY NUMBER: 421712407
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102421(a)

Child's Records

(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review the licensee did not comply with the section cited above Child # 11, Child # 15 , Child # 16 and Child # 17 do not have record availble for review which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/07/2022
	Plan of Correction
1 2 3 4	Licensee agreed to locate the file or create a file with required licensing forms and submit written proof of correction no later than 7/7/2022.

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: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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