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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208638
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:47:38 PM


Document Has Been Signed on 05/25/2022 02:47 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:HOLFORD FAMILY CHILD CAREFACILITY NUMBER:
426208638
ADMINISTRATOR:BLANCHE HOLFORDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 868-0574
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 0DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Blanche HolfordTIME COMPLETED:
02:00 PM
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On 5/25/22, at 11;45 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Blanche Holford, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The FCCH’s great room, family room, guest bedroom, backyard and hallway restroom are used for child care services, while the remaining bedrooms are excluded from child care. At the time of the inspection, no children are present.

Required forms are predominantly posted on the wall near the entry of the FCCH. The FCCH’s living room has a fireplace which covered by glass. The FCCH's restroom used for child care is observed to be clean and free of toxins. LPA observed smoke and carbon monoxide detectors throughout the FCCH. Each detector was tested (12:35 PM and 12:36 PM) and found to be operable. The FCCH has a regulation fire extinguisher on site which was service on 10/6/21. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. The FCCH was void of hazardous items. Medication and cleaning compounds in the FCCH are stored in elevated cabinets in the kitchen. Medication in the FCCH is also stored in bathroom's medicine cabinet which is secured. Both areas where medication is stored is inaccessible to children in care. Toys, furniture and equipment in the FCCH are age appropriate.

The backyard is enclosed by wooden fencing. The fence’s entry/exit gate is secure. Toys and play equipment observed in backyard are age appropriate and in satisfactory condition. Licensee is reminded to replace toys and equipment which start to degrade. LPA observed no bodies of water on site. LPA also observed a shed in the area which is secure and contains toys/ household goods.
(CONT. 809-C)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
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 2


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: 05/25/2022
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LPA reviewed children's records. The records are current, complete and possessed emergency contact information as mandated by regulations. LIcensee has documentation memorializing child sleep checks in intervals of 15 minutes. A review of the FCCH's fire drill log show drills are current with the last occurring on 5/10/22. The Licensee's records are also current and complete with pediatric CPR and First Aid certifications expiring on 3/12/24. The Licensee's Mandated Reporter training certification expires on 12/20/22 . Licensee is reminded to renew certifications and training prior to expirations. The Licensee informed LPA 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 for additional resource. LPA also informed Licensee Blanche Holford 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 conducted and report was reviewed with the Licensee Blanche Holford.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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