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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208638
Report Date: 12/16/2020
Date Signed: 12/17/2020 09:19:26 AM

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:HOLFORD FAMILY CHILD CAREFACILITY NUMBER:
426208638
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/16/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Blanche HolfordTIME COMPLETED:
05:00 PM
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On 12/16/2020, at 4:00 PM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Case Management inspection of the above referenced Family Child Care Home (FCCH) for a change of capacity. LPA met with Blanche Holford, Licensee of the FCCH and discussed the purpose of the inspection. Due to COVID-19 and the California Department of Public Health's guidelines for social distancing, this inspection was conducted via facetime application. Prior to tele-inspection, LPA asked pre- screening questions. The Licensee's responses to the Pre-screening questions suggest the facility is free of COVID exposures.

During this tele-inspection, the Licensee provided the LPA an interior and exterior tour of the FCCH. LPA observed the FCCH's interior and exterior to be free of hazardous materials and/or toxins which would pose a danger to the children in care. At the time of the inspection, there were no children in care.

LPA reviewed he Licensee’s First Aid/ CPR certification which expires on 3/07/2022. LPA observed a regulation fire extinguisher which was last serviced on 10/8/2020

Continued on 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
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 3
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: HOLFORD FAMILY CHILD CARE
FACILITY NUMBER: 426208638
VISIT DATE: 12/16/2020
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Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 12/16/2020.

LPA discussed with the applicant Safe Sleep Regulation, (PIN 20-24).

· Infant up to 12 months of age must be on their backs to sleep, unless there is a medical exemption from a licensed physician that allows for an alternative sleeping position.
· Cribs must be free from all loose articles and objects, including blankets and pillows.
· Mattress must be firm and include a tight-fitted sheet.
· infants must not be forced to sleep, stay awake, or stay in the sleeping area.
· Infants must not be swaddled while in care.
· An infant's head must not be covered while sleeping.
· If an infant fall asleep before being placed in a crib, for example, in a provider's arms or stroller, the provider must move the infant to a crib (or play yard for FCCHs) as soon as possible.
· Car seats will only be used for transportation and must not be used for sleeping within a child care facility.
· All pacifiers cannot have anything attached, such as a stuffed animal or a clip meant to attach the pacifier to the infant's clothing.
· Providers must check on sleeping infants every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness. Continued on 809C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: HOLFORD FAMILY CHILD CARE
FACILITY NUMBER: 426208638
VISIT DATE: 12/16/2020
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· Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.

LPA also advised against sleeping infants in a separate room.

LPA reviewed COVID-19 Self-Assessment Guide with applicant and observed that COVID-19 documents were posted.

THIS REPORT MUST BE FILED IN FACILITY FILE AND MADE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.

The home meets Title 22 of CCR for a Large Family Child Care license effective today,December 16, 2020. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted

Exit interview was conducted with Licensee Blanche Holford. This report along with a copy of the Notice of Site Visit will be sent to Ms. Holford via email with a read receipt or confirmation of receipt of email, which will act as the Applicant's signature.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3