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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426210481
Report Date: 06/02/2021
Date Signed: 06/02/2021 05:37:22 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:HIGGINS FAMILY CHILD CAREFACILITY NUMBER:
426210481
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
06/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Francine HigginsTIME COMPLETED:
05:45 PM
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On June 2, 2021, at 3:45 PM Licensing Program Analyst, (LPA) Jill Laxo conducted a required one year and an increase in capacity inspection. (Per Licensees request) The purpose of the inspection was discussed with the Licensee, Francine Higgins. LPA and Licensee together toured the home inside and out. There were four children in care during the inspection.

The facility is a single story home, the day care is primarily conducted in the play room and outside yard. Detergents, cleaning products, medication and other items which could pose a danger are stored and inaccessible to children. There is a pond on the premises, which is gated and locked. Licensee states there are no firearms in the home. Fire extinguisher is a 2A10BC last serviced July 17, 2020. The home has working smoke and carbon monoxide detectors.

Licensee has all required forms posted. Safe toys and play equipment are provided. The children have safe and comfortable accommodations. Fireplace is screened. Licensee has current roster of children. File were reviewed and have required forms. Licensee has current CPR/First Aid with expiration date of 02/27/2023. Licensee's proof of SB 792 Adult Immunization's verified. AB1207 Mandated Reporter certificate expired in January 2021.

Each crib and play yard has a firm mattress with a fitted sheet. Cribs and play yards are free from all loose articles and there are no objects hanging or attached.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: HIGGINS FAMILY CHILD CARE
FACILITY NUMBER: 426210481
VISIT DATE: 06/02/2021
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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

LPA provided and discussed with the Licensee Safe Sleep Regulation, (PIN 20-24) and Effects of Lead Exposure per AB 2370. Licensee was provided a blank LIC9227 form.



Exit interview was conducted. The home meets Title 22 Division 12 requirements of a large FCCH license. Licensure is pending proof of AB1207 to complete the increase in capacity.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Jill M Hazelhofer-LaxoTELEPHONE: (805) 635-5097
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
LIC809 (FAS) - (06/04)
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