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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213166
Report Date: 04/25/2022
Date Signed: 04/25/2022 03:11:48 PM

Document Has Been Signed on 04/25/2022 03:11 PM - It Cannot Be Edited

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:JIMENEZ FCC AKA JIMENEZ CHILDCAREFACILITY NUMBER:
426213166
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 10CENSUS: 5DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Deyanira JimenezTIME COMPLETED:
03:25 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's assistant responses indicate there was no COVID-19 exposure on site.

On 4/25/2022, at 11:00 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection and met with Licensee's Assistant, Lizzie Mejia. The purpose of the visit was discussed with the assistant and together we toured the inside and outside of the home. LPA observed 4 children and 1 infant in care at the time of the inspection. At 11:56 AM, Deyanira Jimenez, Licensee arrived from running errands.

The main day care areas are living room, dining room, kitchen, activity room, napping room, activity area, and bathroom. LPA observed , at 11:20 AM, the safety gate to the stairs unsecured, leaving the stair accessible to children in care. At 11:22 AM, LPA observed C1 stripped in to a car seat/ stroller, with a blanket covering the infant's head, in the living room. At 11:25 AM, LPA observed DayQuil (cold & flu), nail clippers and nail scissors on the kitchen counter accessible to children in care. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the garage secured with doorknob covers. The backyard is completely fenced. No bodies of water were observed.

Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster.

The fire extinguisher was observed and was purchased March 24, 2022. There is a functioning carbon monoxide detector and smoke alarm that were tested at 11:54 AM, that meets statutory requirements and were functioning at the time of the inspection in the home. Licensee and assistant are current with immunization required per SB 792.
THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: JIMENEZ FCC AKA JIMENEZ CHILDCARE
FACILITY NUMBER: 426213166
VISIT DATE: 04/25/2022
NARRATIVE
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The last Safety drill was last conducted and documented on 4/25/2022. Licensee is current with CPR and First Aid which expires March 6, 2023. Licensee stated that licensee nor assistant have not completed the Mandated Reporter Training required per AB 1207.

On 10/22/21, the Licensee submitted documentation for a FCCH change of capacity. The Licensee is seeking to change the FCCH’s capacity from 8 (Small FCCH) to 14 (Large FCCH). The Santa Maria Fire Department granted a fire clearance following an inspection completed at FCCH on 04/18/2022.

Licensee is not providing Incidental Medical Services. 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: htttp://www.ada.gov/childqanda.htm

LPA reviewed with Licensee the Safe Sleep Regulation, The Effects of Lead, and What is Carbon Monoxide. LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov. Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish. The home meets Title 22 of CCR provisional requirements for a Large Family Child Care license effective today. Effective date of license is today April 25, 2022. LPA provided the Licensee a Notice of Site Visit (LIC 9213) to be posted.

Today, deficiency cited under Title 22 Division 12, Spainsh Appeal rights given.


Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.
SUPERVISORS NAME: Maria Mueller
LICENSING EVALUATOR NAME: Martina Jimenez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2022
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Page: 2 of 5
Document Has Been Signed on 04/25/2022 03:11 PM - It Cannot Be Edited


Created By: Martina Jimenez On 04/25/2022 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JIMENEZ FCC AKA JIMENEZ CHILDCARE
FACILITY NUMBER: 426213166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(3)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (3) Where children are less than five years old are in care, stairs shall be fenced or barricaded.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, at 11:20 AM, the gate to the stairs was unsecured, leaving the stair accessible to children in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2022
Plan of Correction
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Licensee will submit a written plan explaining how licensee will prevent furture occurance of the safety gate leading to the stairs be unsecured during day-care hours. Plan will be submitted via email to Martina.Jimenezz@dss.ca.gov by 4/26/22.

Type A
Section Cited
CCR
102417(g)(4)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation at 11:25 AM, LPA observed DayQuil (cold & flu), nail clippers and nail scissors on the kitchen counter accessible to children in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2022
Plan of Correction
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Licensee will submit a written plan explaining how licensee will prevent furture occurance of medicine, and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Plan will be submitted via email to Martina.Jimenezz@dss.ca.gov by 4/26/22.
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
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 04/25/2022 03:11 PM - It Cannot Be Edited


Created By: Martina Jimenez On 04/25/2022 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JIMENEZ FCC AKA JIMENEZ CHILDCARE
FACILITY NUMBER: 426213166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102425(h)
Infant Safe Sleep
Car seats shall only be used for transportation purposes and shall not be used for sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation , at 11:22 AM, LPA observed C1 stripped in to a car seat/ stroller, in the living room, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2022
Plan of Correction
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Licensee will submit a written plan explaining how licensee will prevent future occurrence of infant's in care from sleeping in a car seat. Plan will be submitted via email to Martina.Jimenezz@dss.ca.gov by 4/26/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Mueller
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 04/25/2022 03:11 PM - It Cannot Be Edited


Created By: Martina Jimenez On 04/25/2022 at 02:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: JIMENEZ FCC AKA JIMENEZ CHILDCARE
FACILITY NUMBER: 426213166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(g)
Infant Safe Sleep
An infant’s head shall not be covered while sleeping.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on At 11:22 AM, LPA observed C1 stripped in to a car seat/ stroller, with a blanket covering the infant's head, in the living room, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2022
Plan of Correction
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Licensee will submit a written plan explaining how licensee will prevent future occurrence of infant's head being covered while the infant is sleeping. Plan will be submitted via email to Martina.Jimenezz@dss.ca.gov by 4/26/22.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs review of files revealed Licensee nor assistant have not completed the Mandated Reporter Training required per AB 1207, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2022
Plan of Correction
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Licensee will submit a verification of Mandated Reporter Training certificate for licensee and assistant to CCLD by May 3, 2022, to LPA via email to Martina.Jimenezz@dss.ca.gov by 4/26/22.
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
LICENSING EVALUATOR NAME:Martina Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022


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