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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212048
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:10:10 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:AGUAYO FAMILY CHILD CAREFACILITY NUMBER:
426212048
ADMINISTRATOR:JOSEFINA AGUAYOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 925-8376
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 6DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Josefina AguayoTIME COMPLETED:
01:15 PM
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On 7/19/2021 at 11:45 AM, Licensing Program (LPA) Analyst Francisca Velazquez and Licensing Program Manager (LPM), Maria Mueller conducted a required Inspection of the facility. Prior to entering the facility, LPA completed COVID-19 pre-screening questionnaire with Assistant and based on Assistant's responses it was determined that facility did not have COVID-19 exposures. LPA and LPM met with Lorena Chavez, Assistant of the facility and explained the purpose of the inspection. Assistant stated that Licensee was heading back to the facility from a doctors appointment. LPA and LPM in the company of Assistant toured the interior and exterior of the facility. This home consists of 4 bedrooms, 3 bathrooms, playroom and backyard. Licensee arrived to the facility at 12:00 PM and continued the inspection tour with LPA and LPM. Licensee stated that children in care have access to the playroom, bathroom and backyard. LPA and LPM observed a small gate by the kitchen making the kitchen and the rest of the home inaccessible to the children in care. At the time of inspection six (6) children were present.

LPA and LPM observed a clean home with plenty of activities for the children in care. The bathroom used for care was clean and free of toxins. LPA and LPM observed cleaning compounds stored in a high cabinet in the kitchen. In addition, Licensee stated that detergent and Clorox are stored in the laundry room that is locked and inaccessible to children in care. LPA observed that all low cabinets in the kitchen have additional safety latches. LPA observed knives, sharps are stored in a high cabinet in the kitchen and are inaccessible to children in care. Licensee stated that medication that is used by her family is stored in her bedroom and not accessible to the children in care. Toys, furniture and equipment in the facility are age appropriate.

Licensee uses the back yard as an outdoor play area. LPA and LPM observed that backyard is completely fenced. Licensee stated that when children play outdoors, children are always supervised by Licensee or assistant. The yard has plenty of shade for children in care. LPA and LPM observed locked sheds in the backyard. Licensee stated that the shed has children items such as diapers, wipes, etc. LPA and LPM reminded Licensee that shed should always be locked and inaccessible to children in care. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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 3
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: AGUAYO FAMILY CHILD CARE
FACILITY NUMBER: 426212048
VISIT DATE: 07/19/2021
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LPA and LPM observed required licensing forms and documentation posted on the wall of the playroom. LPA and LPM observed smoke detector and carbon monoxide detector in the wall of the kitchen. Both smoke detector and carbon monoxide were tested and were found to be operational at 12:11 PM. LPA observed a regulation fire extinguisher in the kitchen of the facility that was serviced on 5/25/21. LPA and LPM reminded Licensee to either service or purchase a regulation fire extinguisher annually. LPA and LPM reviewed the facility emergency drill log. Last drill facility conducted was 1/26/21. LPA and LPM reminded Licensee that emergency drills need to be completed and documented every six (6) months.

Licensee stated that there are no firearms or ammunition stored in the facility.

LPA and LPM reviewed a sampling of the children records. All records reviewed are current and contains complete emergency card information. Facility has a current roster of children enrolled in the facility. LPA and LPM reviewed Licensee's Pediatric CPR and Frist-aid certification which expires 2/27/23 and Mandated Reporter training certificate, AB1207 which expires 8/11/22.

Licensee stated that she does not provide medication in the facility. 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: www.ada.gov/childqanda.htm

LPA and LPM discussed COVID-19 guidance and best practices with the Licensee. During the time of inspection Licensee and Assistant both had face coverings. Licensee stated that she continues to follow all COVID-19 guidance. LPA and LPM discussed safe sleep regulations with Licensee. Licensee currently has two (2) infants enrolled for care. Licensee stated that she is aware of the new safe sleep regulations and is documenting 15 minutes check for all infants and also has LIC 9217 (Individual Infant Sleep Plan) for all infants.

CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
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: AGUAYO FAMILY CHILD CARE
FACILITY NUMBER: 426212048
VISIT DATE: 07/19/2021
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There were no Title 22 deficiencies cited during this visit.

This report was translated in Spanish by LPA Velazquez.

LPA provided Licensee with LIC 9213 (Notice of site visit). Licensee posted LIC 9213 prior to LPA and LPM leaving the facility.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3