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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426212695
Report Date: 06/03/2019
Date Signed: 06/03/2019 04:51:58 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:EUSTACE FAMILY CHILD CAREFACILITY NUMBER:
426212695
ADMINISTRATOR:ALANYA EUSTACEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 757-4335
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 9DATE:
06/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Alanya EustaceTIME COMPLETED:
04:50 PM
NARRATIVE
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An annual random was conducted by LPA S. Mendoza-Ceja who met with Licensee Alanya Eustace.
The home was toured inside and outside. 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 on 09/27/2016. The smoke detector was tested, including the carbon monoxide detector. The child care roster was reviewed. LPA reviewed “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 06/10/2018. Licensee Alanya and her husband Austin's CPR and First Aid cards expired 06/27/2017.

LPA discussed AB 1207 Child Abuse Mandated Reporter Training. Licensee and her husband have not completed the training as required. Licensee was reminded about the requirement for care providers/employees, including volunteers to obtain immunization against Influenza, Pertussis, and Measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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 deficiencies are cited according to CCR, Title 22 Division 12. 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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
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 4
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: EUSTACE FAMILY CHILD CARE
FACILITY NUMBER: 426212695
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
CCR
102417(b)
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102417 (b) Operation of a FCCH: The home shall be kept clean and orderly, with heating and ventilation for safety and comfort
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Please correct by 06/17/2019
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This requirement was not met based on LPA's observation of the home and interview with Licensee. LPA observed the home to be in cluttered with personal clothing and items, including the floor/ and carpet in need of cleaning due to dirt particles.



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Type B
06/17/2019
Section Cited
HSC
1596.8662(b)(1)
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1596.8662 (b) (1) Health and Safety - Child Abuse Mandated Reporter Training: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider...employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Please correct by 06/17/2019
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This requirement was not met as evidenced by the record review and interview which revealed licensee and her husband have not completed the training which poses a potential health and safety risk to 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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: EUSTACE FAMILY CHILD CARE
FACILITY NUMBER: 426212695
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2019
Section Cited
CCR
102417(g)(1)
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102417 (g) (1) Operation of a FCCH: The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: ... The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshal.
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Please submit verification to the Department by 06/04/2019
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This requirement was not met as evidenced by the inspection of the fire extinguisher and interview with licensee revealed the fire extinguisher had not been serviced since 09//27/2016 which poses a potential health and safety risk to children in care.
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Type B
06/17/2019
Section Cited
CCR
102417(g)(9)(A)1
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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.
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Please complete by 06/17/2019.
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This requirement was not met as evidenced by the review of the emergency disaster drill log and interview with licensee revealed the last fire drill was conducted 06/10/2018. This poses a potential health and safety risk to 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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: EUSTACE FAMILY CHILD CARE
FACILITY NUMBER: 426212695
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2019
Section Cited
CCR
102416(c)
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102416 (c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866.
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Please enroll in a course by 06/17/2019.
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This requirement was not met as evidenced by the record review and interview which revealed licensee and her husband both have expired CPR and First Aid cards which poses a potential health and safety risk to 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: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4