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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212122
Report Date: 07/13/2021
Date Signed: 07/14/2021 04:53:07 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:CARDOSO FAMILY CHILD CAREFACILITY NUMBER:
426212122
ADMINISTRATOR:BLANCA CARDOSOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 925-5378
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 9DATE:
07/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Blanca CardosoTIME COMPLETED:
04:00 PM
NARRATIVE
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On 7/13/2021 at 1:45 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Required annual inspection. Due to COVID 19 pandemic, LPA asked Licensee of pre- screening questions related to COVID-19, Licensee's responses to the pre-screening questions suggest no COVID-19 exposure on site. LPA met with Licensee Blanca Cardoso, daughter, Natalie Cardoso and Assistant Victoria Duenas Pardo. LPA discussed the purpose of the Inspection. There were 9 children present 2 of whom were infants.

LPA toured the interior and exterior of the day care. LPA observed required licensing forms are posted in the FCCH (Family Child Care Home). At 2:15 PM, LPA observed smoke and carbon monoxide detectors in the FCCH, both were tested and found functional. The regulation fire extinguisher was serviced on February 8, 2021. Home conducts and documents fire and disaster drill every month. The most recent fire/disaster drill was conducted last July 6, 2021. The bathroom was inspected and observed to be clean and free of toxin. LPA observed the day care is clean, orderly, free of hazardous items at the time of inspection.
The play yard is enclosed by plastic fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 11/16/2021. AB 1207 Mandated Reporter Training was taken on 9/11/2020, Licensee was reminded that Mandated Reporter Training should be renewed every two years. Licensee's assistant who started in May 14, 2021 has no record of immunization on file as required by SB 792 and no tuberculosis clearance. Children's files were reviewed. Licensee maintains copy of the emergency information of the child.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
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: CARDOSO FAMILY CHILD CARE
FACILITY NUMBER: 426212122
VISIT DATE: 07/13/2021
NARRATIVE
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LPA discussed Safe Sleep Regulations with Licensee and provided copy of Infant Sleep Chart. Providers must check on sleeping infants (0 to 24 months) every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness. Each infant, up to 12 months of age, must have an Individual Infant Sleeping Plan (LIC 9227) on file, which will document the infant's sleeping habits, usual sleep environment, and the infant's rolling abilities.

The Licensee 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

The following deficiencies are being cited in accordance to Health & Safety codes. Please refer to LIC 809 D for documentation of deficiencies cited

Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted with Licensee Blanca Cardoso. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights. 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 inspection and report weregigi translated in Spanish by Licensee's daughter, Natalie Cardoso.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
LIC809 (FAS) - (06/04)
Page: 3 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: CARDOSO FAMILY CHILD CARE
FACILITY NUMBER: 426212122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/23/2021
Section Cited

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 (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles....

This requirement is not met as evidenced by:
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Review of facility file revealed that Assistant
does not have record of immunization on file.
Licensee stated she was not aware that it is required for assistant. She always have her chidlren as assistant.
This poses a potential risk to health and a safety of children in care.
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Type B
07/30/2021
Section Cited

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b) The applicant shall provide all of the following information....
(9) Evidence of a current tuberculosis clearance, not more than one year prior to or seven days after initial presence in the home, for any adult in the home during the time that children are under care.
This requirement is not met as evidenced by:
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LPA review of file revealed that Assistant does not have tuberculosis clearance on file. This poses a potential risk to health and safety of children in care.
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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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2021
LIC809 (FAS) - (06/04)
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