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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210089
Report Date: 01/02/2024
Date Signed: 01/02/2024 01:34:36 PM


Document Has Been Signed on 01/02/2024 01:34 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
SANTA BARBARA CC RO, 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:
01/02/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Rosa AndalonTIME COMPLETED:
01:50 PM
NARRATIVE
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On January 2, 2024 at 11 AM, Licensing Program Analyst (LPA's) Susana Martinez and Aaliyah Zendejas conducted an unannounced Required- 3 Year inspection. LPA's met with licensee Rosa Andalon and advised her the purpose of the inspection. Licensee provided LPA's a tour of the home inside and out. There were three infant children in care at the time of the inspection and no other adults in the home.

LPA observed required licensing documents mounted on the wall in the main day-care room. Last disaster and fire drill was conducted on 2/15/2023. Licensee was reminded that drills need to be conducted and documented every 6 months. Fire extinguisher 2A10BC mounted on the wall inside the laundry room was last serviced 10/10/2022. Licensee states that was incorrect, LPA's asked for proof of service in 2023. Licensee could not provide proof of service in 2023. Fire and carbon monoxide detectors were observed throughout the home. Alarms were not tested due to napping children.

Children in care have access to three rooms, one restroom, kitchen, living room, and back yard. Fire place inside the living room is screened to prevent access by children. Kitchen knives are being kept in a cabinet above counters to keep out of reach from children. Children have access to toys that are age-appropriate inside and outside of the home. During the inspection LPA's observed one child sleeping in a room with the door closed, Licensee stated she just closed the door as soon LPA's arrived. At 11:09 AM LPA's found another child sleeping behind a closed door. LPA's reminded Licensee that doors need to be maintained open at all time when children are sleeping.

The outdoor space is enclosed and has a door leading to the rest of the backyard. LPA's observed the door to be open and therefore proceeded to inspect the entire backyard. LPA's asked Licensee if there were any pools, jacuzzis, or other bodies of water in the home. Licensee stated no. LPA's observed a jacuzzi in the backyard. Licensee showed LPA's the hardcover on the jacuzzi. During the tour, LPA did not observe any hazards/toxins items accessible to children in care.

Continued on 809-C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ANDALON FAMILY CHILD CARE
FACILITY NUMBER: 426210089
VISIT DATE: 01/02/2024
NARRATIVE
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LPA reviewed three out of three children files. All children files were current. Licensee CPR/first aid is valid through 2/25/2025. Licensee was reminded a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter certification AB1207 every two years at www.mandatedreporterca.com. Licensee states she is unaware of what a mandated reporter certification is, LPA's provided information and advised Licensee to complete it as soon as possible.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days 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 additional resource. LPA 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. LPA observed 3 out of 3 infants safe sleep documentation to be missing.

Licensee advised there were no children in care that required Incidental Medical Services. 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

Continued on 809-C

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: ANDALON FAMILY CHILD CARE
FACILITY NUMBER: 426210089
VISIT DATE: 01/02/2024
NARRATIVE
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During the exit interview, the LICENSEE Rosa Andalon, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today's inspection four Type B citations and can be found on the attached 809-D. Two technical violations were also issued.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted, appeal and report was reviewed in Spanish with the licensee Rosa Andalon.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/02/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: ANDALON FAMILY CHILD CARE
FACILITY NUMBER: 426210089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as Licensee could not provide proof of service or purchase for the fire extinguisher which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2024
Plan of Correction
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Licensee will submit proof of service to LPA by 01/16/2024.
Type B
Section Cited
CCR
102417(g)(9)(A)
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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as last fire drill was conducted on 02/15/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2024
Plan of Correction
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Licensee will submit proof of drills by 01/16/2024.
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 TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 01/02/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: ANDALON FAMILY CHILD CARE
FACILITY NUMBER: 426210089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2024

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
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Based on observation, interview, record review, the licensee did not comply with the section cited above in 3 out of 3 infants did not have docuemntation of 15 minute checks which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2024
Plan of Correction
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Licensee is to read the Safe Sleep Frequently Asked Questions and submit a written statement on what was learned from the FAQ's. Written statement is due to the Department by 01/16/2024.
Type B
Section Cited
CCR
102425(j)(5)(A)
Infant Safe Sleep
The provider shall supervise infants while they are sleeping and adhere to the following requirements: If the infant is sleeping in a separate room from where the provider is stationed, the door to the room the infant is sleeping in shall remain open at all times. The provider shall be able to visually observe the infant without moving the door.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above in 2 out of 2 infants which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/16/2024
Plan of Correction
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Licensee is to read the Safe Sleep Frequently Asked Questions and submit a written statement on what was learned from the FAQ's. Written statement is due to the Department by 01/16/2024.
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 TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 01/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2024
LIC809 (FAS) - (06/04)
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