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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212048
Report Date: 10/11/2022
Date Signed: 10/11/2022 03:23:01 PM


Document Has Been Signed on 10/11/2022 03:23 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
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: 8DATE:
10/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Josefina Aguayo & Kim CarreonTIME COMPLETED:
03:30 PM
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On 10/11/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Josefina Aguayo, Licensee of the FCCH and Kim Carreon that will be added as a Co-licensee. LPA explained the purpose of the inspection. LPA notes COVID Pre-screening questions were asked of Licensee prior to the inspection. The Licensee's responses suggest the FCCH is void of COVID positive cases. At the time of the inspection, LPA observed eight (8) children on site being cared by three (3) staff.

LPA, in the company of Licensee, toured the interior and exterior of the FCCH. LPA notes that the entrance of the FCCH is through the sliding glass door that goes directly into the daycare room. The FCCH’s daycare room, bathroom, outdoor front and back yard are accessible for childcare services. Meanwhile, kitchen, dinning room, living room, laundry room, all four (4) bedrooms, restroom in the hallway are inaccessible to children in care. LPA observed a small baby gate in the daycare room that makes the rest of the home off-limits.

The FCCH was observed to be clean and orderly. The FCCH has ventilation to afford for the children’s comfort. The FCCH was void of hazardous items. LPA observed medication on top of the refrigerator in the kitchen that is inaccessible to children in care. Licensee reported that more medication is stored in Licensee’s bedroom that is also inaccessible to children in care. Sharps are stored in the kitchen counter and the kitchen is also inaccessible to children in care. Cleaning compounds in the FCCH are stored in an elevated cabinet in the kitchen and in the laundry room that is inaccessible to children in care. The bathroom used for childcare is clean and free of toxins. LPA observed a fireplace in the home that is located in an area that is inaccessible to children in care. Toys, furniture and equipment in the FCCH are age appropriate.

Required forms are predominantly posted on the wall of the daycare room. LPA observed both smoke and carbon monoxide detectors in the FCCH. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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: AGUAYO FAMILY CHILD CARE
FACILITY NUMBER: 426212048
VISIT DATE: 10/11/2022
NARRATIVE
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The detectors were not tested due to children napping at during this inspection. Licensee stated that smoke and carbon monoxide detector are test every two months. The FCCH has a regulation fire extinguisher on site which was service on 5/23/22. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The FCCH maintains working telephone services.

The FCCH uses the back outdoor yard that is enclosed by wood fencing. The fence’s entry/exit gates are secure. Toy’s furniture and play equipment observed in backyard area are age appropriate and in satisfactory condition. Licensee is reminded to replace toys and equipment in the outdoor area when items start to degrade or are not in good repair. The FCCH also uses a small enclosed outdoor space that is located in front of the FCCH. Per Licensee, children are always supervised when playing outdoors. LPA observed no bodies of water on site.

LPA reviewed child’s records. The records are current, complete and possessed emergency contact information and immunization records. A review of the FCCH's fire drill log shows the last drill occurred on 5/18/22. The Licensee's records are also current and complete with pediatric CPR and First Aid certifications expiring on 2/27/23. Licensee’s Mandated Reporter training certificate is being retaken at the moment and will be completed today 10/11/22. Licensee is reminded to renew certifications and training prior to expirations. Licensee would like to add Kim Carreon as a Co-licensee in the FCCH. Co-Licensee completed orientation on 5/13/2022. Preventative Health training was completed on 1/18, 1/19 and 1/20/2022. Co-Licensee’s CPR is valid until 1/29/24 and AB1207 is valid until 4/18/24. LPA observed proof of Tuberculosis and required immunization's. The Licensee informed LPA no firearms or ammunition are stored on site.

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

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 maximum per day/per person will be assessed if this regulation is violated. CONT
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
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: 10/11/2022
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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 for 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.

During today’s inspection, one (1) Type B deficiency is being issued.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Josefina Aguayo and Co-Licensee Kim Carreon.

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

DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/11/2022 03:23 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: AGUAYO FAMILY CHILD CARE
FACILITY NUMBER: 426212048

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

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 in that Licensee is not documenting 15 mintue check for all infants during nap time which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/18/2022
Plan of Correction
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Licensee agrees to start doucmenting 15 mintue checks for all infants ages 0-24 months during nap time. Licensee will develop a systme to document the 15 mintues checks and will send LPA Velazquez proof that 15 mintues checks are being documented via email to Francisca.Velazquez@dss.ca.gov by 10/18/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
LIC809 (FAS) - (06/04)
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