426213814-2-21-2020-17-CC-EBAY-BLZPV3-20200221103828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426213814
Report Date: 02/21/2020
Date Signed: 02/21/2020 10:38:35 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:	STEGENGA FCC AKA HARMONY KIDS DAYCARE		FACILITY NUMBER:	426213814
ADMINISTRATOR:	SAMANTHA STEGENGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 423-3527
CITY:	ORCUTT	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 12	DATE:	02/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Samantha Stegena		TIME COMPLETED:	10:40 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	On February 21, 2020, at 8:30 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Required Annual inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Samantha Stegena, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of the Licensee, toured the interior and exterior of the FCCH. The home’s converted indoor courtyard ("classroom"), living room and hallway bathroom are used for child care, while the remainder of the home is excluded from child care and barricaded with child safety gates. At the time of the inspection, 11 children are present and Assistant Gabriella Fuentes is on site. Required forms are posted on the wall at the entry of the classroom. The home’s living room has a fireplace which is screened by glass and inaccessible to children. LPA observed operable smoke and carbon monoxide detectors in the FCCH. Likewise, the home has a regulation fire extinguisher which was service on March 26, 2019. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. LPA reviewed the home’s fire/disaster drill documentation. The documentation noted the last fire/disaster drill occurring on January 22, 2020. The home was orderly and the bathroom used for care was clean and free of toxins. Medication in the FCCH is stored in a medicate cabinet in the master bedroom. LPA also observed cleaning compounds stored in the FCCH's garage which inaccessible to children. Toys, furniture and equipment observed in the FCCH are age appropriate. The backyard is enclosed by wooden fencing and the entry/exit gates were secure. The backyard is partition into two activity areas. Toys and play equipment observed in the backyard's activity areas are age appropriate. A dog is housed in the FCCH. LPA viewed the vaccination records for the dog which are found to be current. No bodies of water are observed on site. CONT. 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: STEGENGA FCC AKA HARMONY KIDS DAYCARE	FACILITY NUMBER: 426213814
	VISIT DATE: 02/21/2020

NARRATIVE

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LPA reviewed the children records. The records were current and complete. Each record contained updated immunization information as well as signed Notifications of Parent’s Rights forms. A current roster of children was reviewed by the LPA. The children noted in the roster were present and on site. Licensee's records are also current and complete with Pediatric CPR and First Aid certifications expiring on March 30, 2021 (EMSA approved). Mandated Reporting training was completed by the Licensee.

Licensee stated no firearms or ammunition are stored on site.

The Licensee is not providing Incidental Medical Services (IMS). Policy was discussed. 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 a copy of “Child Care Providers Guide to Safe Sleep." LPA reviewed and provided “Effects of Lead Exposure” leaflet to be distributed to the parents of children in care. Licensee was reminded of the responsibility to know the regulations for FCCH which can be accessed on-line at www.ccld.ca.gov.

In areas evaluated, no deficiencies observed.
LPA observed Licensee post the Notice of Site visit (LIC 9213).

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin Baddley	TELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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