426213156-10-29-2019-17-CC-MKST-BHENNT-20191029103715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426213156
Report Date: 10/29/2019
Date Signed: 10/29/2019 10:37:27 AM

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:	MONROY FCC AKA CREATIVE CARE FOR CHILDREN		FACILITY NUMBER:	426213156
ADMINISTRATOR:	DANIELLE MONROY		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 963-9681
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93103
CAPACITY:	14	CENSUS: 7	DATE:	10/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Danielle Monroy		TIME COMPLETED:	10:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Melissa Stewart, conducted an unannounced annual/random inspection and met with licensee, Danielle Monroy. The purpose of the inspection was explained and the home was toured inside and out. All required forms are posted in a prominent location. At the time of inspection, there were 7 children supervised by one assistant (S1) and licensee. The family child care home operates on the first floor and backyard of the home. LPA observed age appropriate toys, books and furnishings in the indoor activity area. The bathroom used by children was observed to be clean and free of toxins. Two bedrooms downstairs are off limits and kept locked during operating hours. The upstairs is off limits and is made inaccessible by a child safety gate. All hazardous items are stored inaccessible to children in care. Licensee stated there are no guns or ammunition in the home. LPA observed climbing structure on grass, fruit trees, playhouse, bikes, art easels and tables in the backyard which is completely fenced; there are no bodies of water. Carbon monoxide and smoke detectors were tested and operational. Licensee completes and documents emergency drills. The most recent drill was held on 5/17/19. Licensee and assistants are CPR and first aid certified through 2/6/20. Licensee did not have record of immunization per SB 792 requirement for her assistant on file. S1 signed a written declaration indicating that S1 has had the required immunizations. Mandated Reporter Training per AB 1207 was completed by licensee and assistants on 12/13/18. Facility roster and a sample of children's records were reviewed and found complete. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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: MONROY FCC AKA CREATIVE CARE FOR CHILDREN	FACILITY NUMBER: 426213156
	VISIT DATE: 10/29/2019

NARRATIVE

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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: www.ada.gov/childqanda.htm

LPA reviewed and provided Licensee with Safe to Sleep brochure. LPA provided “Effects of Lead Exposure” brochure to be distributed to all families. Licensee was advised to review Quarterly Updates and Provider Information Notices (PINs) which can be accessed on-line at www.ccld.ca.gov.

See LIC 809-D for cited deficiencies in accordance with according to the California Code Regulations Title 22, Division 12 and/or Health and Safety Code. Appeal rights provided.

LPA observed Licensee post the Notice of Site visit.

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

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: MONROY FCC AKA CREATIVE CARE FOR CHILDREN	FACILITY NUMBER: 426213156
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/29/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/29/2019 Section Cited	1 2 3 4 5 6 7	Immunization requirements- 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....The family day care home shall maintain documentation... in the person’s personnel record that is maintained by the FCCH. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on record review and licensee's statement that she does not have S1's immunization record on file, licensee failed to ensure that a record of S1s immunizations were on file at the family day care home. This poses a potential risk to the halth and safety of children in care.	8 9 10 11 12 13 14
Type B 11/01/2019 Section Cited	1 2 3 4 5 6 7	Operation of a Family Child Care Home- 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. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA observation that fire extinguisher had not been serviced since 8/21/2017 (according to the tag on the fire extinguisher). However, the needle indicated that the fire extingusher was still "green." Licensee stated that the fire extinguisher had been serviced in August 2019, but could not provide documentation at time of inspection.	8 9 10 11 12 13 14	This poses a potential risk to the health and safety of children in care.

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 Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Melissa K Stewart	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019

LIC809 (FAS) - (06/04)

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