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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212584
Report Date: 01/13/2020
Date Signed: 01/13/2020 04:53:19 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:CARMONA FAMILY CHILD CAREFACILITY NUMBER:
426212584
ADMINISTRATOR:MARIA CARMONAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 563-5326
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:14CENSUS: 8DATE:
01/13/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Maria CarmonaTIME COMPLETED:
05:00 PM
NARRATIVE
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A Required - 1 Year inspection was conducted by LPA S. Mendoza-Ceja who met with Licensee Maria Carmona and her adult daughter Jessica who were providing care to eight (8) children. Jessica Carmona translated the report to Spanish. The home was toured inside and outside. Licensee adult daughter stated there are no firearms, ammunition or bodies of water on the premises. LPA did not observe any bodies of water. There is a 2 A10 BC Fire Extinguisher which was serviced on 09/03/2019. LPA reminded Licensee to service or replace the fire extinguisher yearly. There is a dual smoke/carbon monoxide detector in the home which was tested. The child care roster was reviewed. LPA reviewed and provided copies of the handouts “A Child Care Provider’s Guide to Safe to Sleep, Safe Sleep in Child Care and Effects of Lead Exposure. The last emergency drill was conducted on 02/18/2019. Licensee Maria Carmona's CPR and First Aid is current (expires 07/17/2021). LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA reminded Licensee, each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year or obtain a sign statement declining the influenza vaccination. LPA also reviewed the requirement for AB 1207 Child Abuse Mandated Reporter Training.

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

The following Type B deficiency is cited according to CCR, Title 22, Division 12 on page 2 in regards to conducting and documenting the emergency disaster drills. Appeal Rights Reviewed.

The "Notice of Site Visit" was posted at the visit.
Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 civil penalty.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020
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: CARMONA FAMILY CHILD CARE
FACILITY NUMBER: 426212584
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2020
Section Cited

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102417(g)(9)(A)1 Operation of a FCCH: Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
This requriement was not met
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evidenced by LPAs interview and review of records that revealed the last fire drill/and or diaster drill was conducted on February 18, 2019 which is more than six months. This poses a potential risk to the health and safety of chidlren 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2020
LIC809 (FAS) - (06/04)
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