426209899-4-6-2023-17-CC-MBRT-CQMPZ2-20230406114450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426209899
Report Date: 04/06/2023
Date Signed: 04/06/2023 11:45:01 AM

Document Has Been Signed on 04/06/2023 11:45 AM - 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:	FLORES FCC AKA SILVIA'S DAYCARE		FACILITY NUMBER:	426209899
ADMINISTRATOR:	SILVIA FLORES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 733-5272
CITY:	LOMPOC	STATE: CA	ZIP CODE:	93436
CAPACITY:	14	CENSUS: 10	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:41 AM
MET WITH:	Silvia Flores		TIME COMPLETED:	12:03 PM

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	On April 6th, 2023, at 9:41AM Licensing Program Analyst (LPA) Rosie Breault conducted an unannounced Annual/Random inspection. LPA met with licensee Silvia Flores and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. At the time of the inspection there ten (10) children and (1) assistant (fingerprint cleared) present. This is a one-story home with 3 (three) bedrooms and two (2) bathrooms, kitchen, two (2) living rooms, dining room, and outdoor play area. LPA observed all required documents posted in a prominent location. All three (3) bedrooms and one (1) bathroom were made inaccessible by locks. Children have access to both living rooms, dining room, kitchen, one (1) bathroom and outdoor play yard. A fireplace is present in the home, secured by a gate. In the restroom children use, LPA observed one (1) can of hair product in an aerosol can on the top of the toilet, medicine cabinet not locked with poisons and razors located inside, and shower to contain personal cleaning products on the flooring. This bathroom was accessible to children at the time of the inspection. This is a violation of Title 22 Division 12, and a Type A violation is cited. Kitchen knives, cleaning supplies and combustibles are inaccessible to children. LPA observed a 2A10BC fire extinguisher with service date of July 1st, 2022, mounted on the wall in the kitchen readily accessible. Licensee advised to ensure the fire extinguisher is serviced or a new one in purchased every year. The last emergency drill was conducted on November 22nd, 2022. Individual carbon monoxide and smoke alarms were tested at 9:55AM and were functioning at the time of inspection. LPA observed age-appropriate toys and furniture readily accessible to children in care. The play yard is enclosed with a fence and no bodies of water are present. Licensee stated no firearms or ammunition are present on the property. Licensee stated no incidental medical services are being provided at this time. CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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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Document Has Been Signed on 04/06/2023 11:45 AM - 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FLORES FCC AKA SILVIA'S DAYCARE	FACILITY NUMBER: 426209899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

102417(g)(4)

Operation of A Family Child Care Home

(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) 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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee to provide photographic evidence of all poisons, combustibles, cleaning compounds and medicines in the bathroom used by children, rendered inaccessible to LPA at maryrose.breault@dss.ca.gov by 4/19/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/06/2023 11:45 AM - 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FLORES FCC AKA SILVIA'S DAYCARE	FACILITY NUMBER: 426209899
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

102425(j)(2)

Infant Safe Sleep

The provider shall supervise infants while they are sleeping and adhere to the following requirements: The provider shall check and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on licensee statement and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee to provide completed 15 minute check log for the period of 4/7/2023-4/18/2023 to LPA at: maryrose.breault@dss.ca.gov by 4/19/2023.

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
1 2 3 4	Based on licensee statement and record review the licensee did not comply with the section cited above in 2 counts which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/19/2023
	Plan of Correction
1 2 3 4	Licensee and assistant (employee) are to complete Mandated Reporter Training and provide copy of certificates to LPA at maryrose.breault@dss.ca.gov by 4/19/2023.

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: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FLORES FCC AKA SILVIA'S DAYCARE	FACILITY NUMBER: 426209899
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA observed the facility roster was current. A sampling of children records was reviewed, and LPA observed licensee had not been completing Safe Sleep 15 Minute Checks. This is a violation of Title 22 Division 12, and a Type B citation is cited. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Licensee’s Pediatric CPR/First-Aid certificate is current and valid until 1/22/2025. Licensee's and assistant’s Mandated Reporter certificate was not present, and the time of the inspection and licensee stated it is not completed. This is violation of Health and Safety Code, and a Type B citation is issued.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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.
CONTINUED ON LIC809C

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: FLORES FCC AKA SILVIA'S DAYCARE	FACILITY NUMBER: 426209899
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA discussed the safe sleep regulations with licensee 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 additional resource. LPA also informed licensee [facility representative] 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.

LPA provided licensee Safe Sleep FAQ’s in Spanish, and courtesy 15 minute Sleep Log Drill.

Citations are recorded on LIC809D.

Exit interview conducted, report was reviewed with the licensee, copy provided. LPA provided licensee Appeal Rights and LIC9224.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Maryrose Breault	TELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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