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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212690
Report Date: 02/14/2020
Date Signed: 02/14/2020 04:06:33 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:OWENS FAMILY CHILD CAREFACILITY NUMBER:
426212690
ADMINISTRATOR:GEORGETTE OWENSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 570-6138
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:14CENSUS: 2DATE:
02/14/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Georgette OwensTIME COMPLETED:
04:15 PM
NARRATIVE
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An annual random was conducted by LPA S. Mendoza-Ceja who met with Licensee Georgette Owens who was providing care to her two grandchildren. The home was toured inside and outside. Child care is conducted in the primary day care room. Licensee stated there are no firearms, ammunition or bodies of water on the premises. LPA did not observe any bodies of water. The fire extinguisher was serviced October, 2017 and is required to be service yearly. There is a smoke and carbon monoxide detector in the home. The child care roster was reviewed. LPA reviewed and provided copy of the handout “Safe Sleep in Child Care, Effects of Lead Exposure, Reporting Child Abuse and Neglect. LPA reviewed the emergency drill log. Licensee's Adult, Infant and Child CPR and First Aid is current (expires 09/2020). LPA reviewed record keeping requirements. LPA discussed the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. LPA reviewed verification of immunization for Licensee. LPA also advised, 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 certificate of completion of the AB 1207 Child Mandated Reporter Training which was completed on 03/26/2018. Licensee was reminded she needs complete the Child Mandated Reporter Training every two years.

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 on page 2 in regards to the fire extinguisher.
Appeal Rights reviewed and provided. The Notice of Site Visit was posted.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
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 2
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: OWENS FAMILY CHILD CARE
FACILITY NUMBER: 426212690
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/17/2020
Section Cited

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Operation of a FCCH: The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include.... The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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The above regulation was not met as evidenced by the Licensee's failure to ensure the 2 A10 BC Fire Extinguisher is serviced yearly as required. The 2 A10 BC Fire Extinguisher was last serviced October 2017. This poses a potential risk to the 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2020
LIC809 (FAS) - (06/04)
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