426200266-8-18-2022-17-CC-GRES-CHERB2-20220818125201

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426200266
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:52:09 PM

Document Has Been Signed on 08/18/2022 12:52 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:	MONTEJANO FCC AKA SOMERSET DAY CARE		FACILITY NUMBER:	426200266
ADMINISTRATOR:	MONTEJANO, CAROL		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 967-6298
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY:	14	CENSUS: 8	DATE:	08/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Carol Montejano		TIME COMPLETED:	12:52 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 August 18, 2022, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced 1 Year Required Inspection and met with Licensee and Assistant, Ms. Carol Montejano and Ms. Victoria Quinn. LPA asked Covid-19 screening questions, assistant's responses indicate there are no COVID 19 exposure on site. Assistant provided LPA a tour of the facility inside and out. There were eight 8 children and 2 staff present during the inspection 5 of the children are licensee's grand children. During the tour LPA observed the following, required forms are posted in the prominent location. Appropriate fire extinguisher was purchased on 8/18/2022. LPA observed the carbon monoxide and smoke detectors in the home. Toxins and detergent are kept in a locked kitchen cabinet inaccessible to children in care. Assistant stated, day care children uses the covered patio, backyard, fenced backyard and the front yard for day care activities. LPA observed the fully fenced swimming pool with the locked gate. Licensee stated there are no guns and ammunition on site. LPA observed cluttered area in the living room with boxes and toys that are not being used. Assistant stated that they are rotating the toys and will be keeping away toys that are not needed. LPA reviewed the following documents, Pediatric CPR and First Aid Card expires 3/2023. Licensee's Mandated Reporter Training Certificate expires on 01/20/2024. Licensee's immunization record is not on file. Fire and Disaster drill is conducted every month. Last drill was conducted on 7/27/2022. Children’s roster is current. LPA reviewed children records. The records are current, complete and possessed emergency contact information as mandated by regulations.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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: MONTEJANO FCC AKA SOMERSET DAY CARE	FACILITY NUMBER: 426200266
	VISIT DATE: 08/18/2022

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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 current Safe Sleep and Covid-19 requirements with Licensee.
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.

During today's inspection deficiency was cited under California Code of Regulation Title 22 Division 12. Deficiency was documented under LIC 809 D.

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

Exit interview conducted and report was reviewed with Licensee, Ms. Carol Montejano and Assistant, Ms. Victoria Quinn

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/18/2022 12:52 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: MONTEJANO FCC AKA SOMERSET DAY CARE	FACILITY NUMBER: 426200266
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 record review, the licensee did not comply with the section cited above Licensee's immuniation record is not on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/29/2022
	Plan of Correction
1 2 3 4	Licensee agreed to submit proof of immunization to Community Care Licensing no later than 8/29/2022.

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: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC809 (FAS) - (06/04)

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