<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426208983
Report Date: 08/30/2019
Date Signed: 08/30/2019 11:27:52 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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
426208983
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
08/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Irma DiazTIME COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
(1) Licensing Program Analysts (LPAs) Ruth Gull and Rene Mancinas made an unannounced RANDOM ANNUAL and INCREASE IN CAPACITY inspection to the home. Met with Irma Diaz, Licensee and explained the purpose of the inspection. LPA Mancinas provided Spanish translation. There were 4 children present. A tour of the home was made both inside and outside. Licensee uses the living room, day care room and hall bathroom for the day care. The regulation fire extinguisher was purchased on 08/25/19. Licensee is reminded to either service or purchase a regulation fire extinguisher every year. The smoke detector and carbon monoxide detector were tested and observed to be functioning. LPAs observed that there are age appropriate toys and equipment. Licensee uses the front yard for the day care and it is completely enclosed by a fence with a gate. LPAs reviewed a sampling of children's records. Licensee's First Aid/CPR certificates are valid until 08/03/20. Licensee states that she does not have any guns/weapons on the property. LPAs reviewed mandated AB 1207 reporter training certificate. Licensee has 1 large dog (license and vaccines are current).
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 is reminded that she is responsible for knowing the regulations for a Family Child Care Home and that Licensing information can be accessed online at www.ccld.ca.gov. LPAs reviewed and provided Licensee with Safe Sleep Awareness information and Effects of Lead Exposure pamphlet (which Licensee is to provide to all current and future parents).

CONTINUED ON LIC 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
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: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 426208983
VISIT DATE: 08/30/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The Fire Clearance was approved on 08/23/19 for 14 children.
LPAs reviewed capacity requirements with Licensee.
The home is licensed for 14 children effective today.

No deficiencies were cited during today's inspection.

The LIC 9213 (Notice of Site Visit) was posted.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Ruth GullTELEPHONE: (805) 895-4073
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2