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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208978
Report Date: 06/12/2023
Date Signed: 06/12/2023 04:38:55 PM


Document Has Been Signed on 06/12/2023 04:38 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:PADILLA FCC AKA MI CASA LA CIGUENAFACILITY NUMBER:
426208978
ADMINISTRATOR:MARIA PADILLAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 478-3338
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 10DATE:
06/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Maria PadillaTIME COMPLETED:
03:30 PM
NARRATIVE
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On 06/12/2023, at 12:55 PM, Licensing Program Analysts (LPAs) Martina Jimenez and Dixie Wright conducted an unannounced Required Annual Inspection of the Padilla Family Child Care Home. LPA met with Maria Padilla, Licensee, the purpose of the visit was discussed with the Licensee and the inside and outside of the home was toured. LPAs observed ten children in care at the time of the inspection.

The main day care areas are Living room, dining room, kitchen and bathroom. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the two bedrooms not secured with a lock. LPAs toured the bedrooms and did not see any hazards. LPAs advised Licensee get safety door knob covers on the doorknobs for back bedrooms. There were no sleep logs to review for the infants in care. The backyard is completely fenced. LPA observed age appropriate toys, bikes, play structure and playhouses. LPA observed required licensing forms and documents posted on the wall in the living room.

No bodies of water were observed. Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. Sampling of children's records were reviewed. The fire extinguisher was observed and was serviced on 05/17/2023. There is a functioning carbon monoxide detector and smoke alarm that meets statutory requirements, both were tested at 1:18PM and functioning at the time of the visit.
This Report Continues on LIC 809C and 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PADILLA FCC AKA MI CASA LA CIGUENA
FACILITY NUMBER: 426208978
VISIT DATE: 06/12/2023
NARRATIVE
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Licensee is current with immunization required per SB 792. The last Safety drill was conducted May 3rd, 2023. Licensee is current with CPR and First Aid which expires June 19th, 2024.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. 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: htttp://www.ada.gov/childqanda.htm

Licensee has completed the Mandated Reporter Training that is required per AB 1207 on October 9, 2022, Assistant has not. LPA reviewed the handout "A Child Care Provider's Guide to Safe Sleep" (PIN 20-24) and Effects of Lead Exposure. LPA provided information for Reporting Child Abuse and Neglect Training, provided online at www.ccld.ca.gov. 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 for additional resource. LPAs also informed Licensee 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. The inspection visit was conducted in Spanish and report was translated in Spanish by LPA Jimenez.

A Notice of Site visit was given and must remain posted for 30 days, or it may result in a $100 civil penalty. Deficiency cited on 809-D, under Title 22, Division 12. Spanish Appeal Rights given.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/12/2023 04:38 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: PADILLA FCC AKA MI CASA LA CIGUENA
FACILITY NUMBER: 426208978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(b)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one out of one pack and play, which poses/posed a potential health, safety or personal rights risk to persons in care. LPA's observed a blanket and stuffed animal in the pack in play, with child #2 in the pack in play. LPA's observed the Pack N Play diaper changing table on top of the Pack N Play.
POC Due Date: 06/12/2023
Plan of Correction
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The blanket, stuffed animal and diaper changing table was removed while LPAs were present; Deficiency cleared.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of two people which poses a potential health, safety or personal rights risk to persons in care. Assistant did not have Mandated Reporter Training.
POC Due Date: 06/19/2023
Plan of Correction
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Per Licensee, Assistant will take the required Mandated Reporter Training. Proof of Correction will be sent to Martina Jimenez by 06/19/2023. Martina.Jimenez@dss.ca.gov
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) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 06/12/2023 04:38 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: PADILLA FCC AKA MI CASA LA CIGUENA
FACILITY NUMBER: 426208978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, the licensee did not comply with the section cited above in three out of three children which poses a potential health, safety or personal rights risk to persons in care. Licensee is not documenting fifteen minute checks on infants.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee was provided the 15 minute check document. Licensee stated she will conduct and document 15 minute checks on infants while they are napping. Proof of Correction will be sent toMartina Jimenez by 06/19/2023. Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 06/12/2023 04:38 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: PADILLA FCC AKA MI CASA LA CIGUENA
FACILITY NUMBER: 426208978

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
101212(a)(c)
Reporting Requirements- Each Licensee shall furnish to the Department reports as required by the Department, including but not limited to the following: The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in one out of one structural changes, which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed an additional two bedroom, one bathroom, additional living space that was built in the backyard. CCLD was not notified of the additional construction of the building. There was also a new patio covering observed attached to the home at the backdoor.
POC Due Date: 06/19/2023
Plan of Correction
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Licensee will submit the final approval of permits from the planning department for the additional buidling and patio covering. Licensee will submit a new facility sketch showing the building. Proof of Correction will be sent to Martina Jimenez by 06/19/2023. Martina.Jimenez@dss.ca.gov
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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) 562-0410
LICENSING EVALUATOR NAME: Dixie Marie WrightTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2023
LIC809 (FAS) - (06/04)
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