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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426206654
Report Date: 01/16/2020
Date Signed: 01/16/2020 12:46:45 PM

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:FERREIRA FAMILY CHILD CAREFACILITY NUMBER:
426206654
ADMINISTRATOR:VIRGINIA FERREIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 354-0958
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 5DATE:
01/16/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Virginia FerreiraTIME COMPLETED:
12:57 PM
NARRATIVE
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Licensing Program Analysts (LPA) Martina Jimenez conducted a required comprehensive inspection and met with Virginia Ferreira, Licensee, Moises Ferreira, Licensee's husband and Jacqueline Ferreira, Licensee's daughter. LPA informed Licensee the reason for the visit. LPA observed 5 children playing in the home. LPA observed age appropriate tables, chairs, books toys and games. The main day care areas are the living room, dining room, and hallway bathroom. LPA observed in the master bedroom medications, coins, hygiene products, wine bottle and cleaning products, ect.. accessible to children. The outdoor play area is completely fenced, LPA observed bike area, plastic play structure and shade area.

Licensee stated that there are no guns or ammunition in the home. There are no bodies of water observed in the home. Licensee is not licensed through Foster Care. There is a functioning carbon monoxide detector that meets statutory requirements. The smoke alarm was tested and was found operational. The fire extinguisher was serviced August 6, 2019.

Licensee is not providing Incidental Medical Services. 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
Report Continues on LIC 809 C and LIC D.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: FERREIRA FAMILY CHILD CARE
FACILITY NUMBER: 426206654
VISIT DATE: 01/16/2020
NARRATIVE
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The Mandated Reporter Training per AB 1207 is currently unable in Spanish. Licensee is current with immunization requirements per SB 792. Licensee conducted and documented safety drills, last drill was conducted January 16, 2020. Licensee is current with CPR and First Aid which expires February 2, 2021. Children's records were reviewed. Children's roster was found complete and updated. All required State forms were posted at the main entrance of the home.

LPA provided and informed licensee Guidelines to Safe Sleep and Effects of Lead Exposure per AB 2370. LPA was provided a brochure on Mandated Reporter Training.

The visit and the report was translated in Spanish by LPA Jimenez.

Today, deficiency cited under Title 22 Division 12 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 LIC 809 and LIC 809 D.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS. LPA observed the "Notice of Site Visit" posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: FERREIRA FAMILY CHILD CARE
FACILITY NUMBER: 426206654
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2020
Section Cited

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102417(g)(4)The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.
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This requirement was not met, based on LPAs observation that in the master bedroom medications, coins, hygiene products, wine bottle and cleaning products, ect.. were accessible to children. This poses an immediate risk to children in care.
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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) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: FERREIRA FAMILY CHILD CARE
FACILITY NUMBER: 426206654
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2020
Section Cited

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102421 Child's Records
Children's Files were reviewed and found a file to be incomplete.
--This was evidenced by Licensee Ferreira's failure to have the required documents.
-Review of 4 of 5 files were available and revealed one child's files was missing. The following form were missing for the file: signed Parent's Right's form,
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Emergency Information, and Consent for Medical form. Licensee was advised this poses a potential risk to children in care.
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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) 387-5041
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4