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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210089
Report Date: 06/23/2021
Date Signed: 06/23/2021 03:45:57 PM

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:ANDALON FAMILY CHILD CAREFACILITY NUMBER:
426210089
ADMINISTRATOR:ROSA ANDALONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 686-1529
CITY:SANTA YNEZSTATE: CAZIP CODE:
93460
CAPACITY:14CENSUS: 3DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rosa AndalonTIME COMPLETED:
03:45 PM
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On 6/23/2021, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Required inspection and met with Licensee, Rosa Andalon. Due to COVID-19 pandemic, LPA asked the pre screening questions before the inspection, Licensee's responses indicate no COVID-19 exposure on site.

LPA toured the interior and exterior of the home. There were 3 children present The home was observed to be clean and orderly with heating and ventilation for safety and comfort. The back yard is enclosed with wooden fence, age appropriate toys and equipment were observed. LPA observed secured hot tub without water. Licensee stated there are no guns or ammunition in the home.

At 2:53 PM, LPA observed carbon monoxide and smoke detectors. 2A10 BC fire extinguisher was serviced on 10/27/2020.

Medication and cleaning compounds are stored inaccessible to children in care. LPA observed appropriate toys and equipment in the day care area. Required licensing forms are posted on the wall at the day care area.

Facility file was reviewed. Pediatric CPR for Licensee expires on 2/25/2023. Licensee has complete required immunization per SB 792.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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: ANDALON FAMILY CHILD CARE
FACILITY NUMBER: 426210089
VISIT DATE: 06/23/2021
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LPA randomly reviewed children records. Licensee maintains copy of the emergency information of the child, children's roster is current .

LPA reviewed and provided Licensee with the Safe Sleep Regulations and form LIC 9227 Individual Infant Safe Sleeping Plan. LPA reiterated that crib or play yards shall be free from all loose articles, and sleeping infant (0 -24 months) supervision and documentation every 15 minutes. LPAs provided the web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing.

The FCCH is not providing 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: www.ada.gov/childqanda.htm

LPA provided the web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing.

Exit interview was conducted with Licensee. Home is in compliance of Title 22 Division 12 California Code of Regulation and Health and Safety Code.


THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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