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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426203658
Report Date: 06/02/2022
Date Signed: 06/02/2022 02:58:19 PM


Document Has Been Signed on 06/02/2022 02:58 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
426203658
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 928-9387
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 5DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Maria Del Carmen RodriguezTIME COMPLETED:
03:05 PM
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On 6/2/22, at 1:20 PM Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced Required inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Maria del Carmen Rodriguez, Licensee of the FCCH and explained the nature and purpose of the inspection. Prior to entering the home, LPA conducted COVID-19 pre-screening questionnaire and based on Licensee's responses it was determined that the home is safe and free of any COVID-19 exposures. LPA notes five (5) children are on site along with Licensee's Spouse, Nicolas Rodriguez.

LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. The home’s living room, kitchen and dining area, day-care room, bathroom in the day-care room and outdoor yard are used for child care services, while the bedrooms, and garage are excluded from services.

The FCCH is orderly and has ventilation to afford for the children’s comfort and safety. Medication in the FCCH is stored in an elevated cabinet in the kitchen. Sharps are stored in an elevated cabinet in the kitchen. Cleaning compounds were observed to be stored in an elevated area in the day-care room and in the garage, both areas are inaccessible to children in care. Toys, furniture and equipment observed in the FCCH are age appropriate.

Required forms are posted on the FCCH living room wall. The FCCH has smoke and carbon monoxide detectors which were tested at 1:44 pm and found to be operable. The FCCH has a regulation fire extinguisher which was serviced 6/17/21. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill documentation. The last drill was completed on 2/12/22.

The outdoor play yard is completed fenced. LPA notes that part of the yard has been made inaccessible to children in care. LPA notes that the yard affords plenty of shade for the children. Toys, furniture and equipment observed in the yard are age appropriate. LPA observed no bodies of water on site. LIC 809-C

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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: RODRIGUEZ FAMILY CHILD CARE
FACILITY NUMBER: 426203658
VISIT DATE: 06/02/2022
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A sampling of the children's records were reviewed. The records are current, complete and possessed emergency contact information. The Licensee's records were also reviewed and found to be complete. Licensee’s Pediatric CPR and First (EMSA approved) expires 2/20/23 and Mandated Reporter certificate expires 6/12/22. LPA reviewed assistant's records and found them to be current and complete. Assistant's Pediatric CPR and First (EMSA approved) expires 2/20/23 and Mandated Reporter certificates expires on 6/11/22.

The Licensee notes no firearms or ammunition are stored on site.

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 as an additional resource. LPA also informed licensee [facility representative] 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.

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

Exit interview and report was reviewed with the licensee, Maria del Carmen Rodriguez. This inspection and review of report was conducted in Spanish due to Spanish being the primary language of the licensee.

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

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
LIC809 (FAS) - (06/04)
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