<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426213814
Report Date: 02/03/2022
Date Signed: 02/03/2022 11:52:26 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 SAMANTHA STEGENGA HARMONY KIDSFACILITY NUMBER:
426213814
ADMINISTRATOR:SAMANTHA STEGENGAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 423-3527
CITY:ORCUTTSTATE: CAZIP CODE:
93455
CAPACITY:14CENSUS: 4DATE:
02/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Samantha StegengaTIME COMPLETED:
11:55 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 2/2/2022, 9:15 AM Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced Required annual inspection of the above Family Child Care Home (FCCH). LPA asked Licensee of pre- screening questions related to COVID-19, Licensee's responses suggest no COVID-19 exposure on site. LPA met with Licensee Samantha Stegenga and discussed the purpose of the Inspection. There were 4 children present during the inspection. FCCH operates Tuesdays and Thursdays, 8:45 AM to 1:30 PM.

LPA toured the interior and exterior of the day care. LPA observed required licensing forms are posted in the FCCH (Family Child Care Home). LPA observed smoke and carbon monoxide detectors in the FCCH.. The regulation fire extinguisher was present but no proof of purchase nor service card. Home conducts and documents fire and disaster drill every 6 months. . The bathroom was inspected and observed to be clean and free of toxin.

The play yard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. LPA observed a trampoline and reviewed the Trampoline Conditions with Licensee which the FCCH is adhered to. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home

LPA Reyes reviewed facility file, Pediatric CPR and First Aid expired on 3/30/2021. Mandated Reporter Training per AB 1207 expires on 2/21/2022. Licensee was reminded that Mandated Reporter Training should be renewed every two years. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements. FCCH conducts and documents fire and disaster drill every month

Continued on 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
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 3
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 SAMANTHA STEGENGA HARMONY KIDS
FACILITY NUMBER: 426213814
VISIT DATE: 02/03/2022
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
26
27
28
29
30
31
32
 A sampling of children records were reviewed and found to be current. File contains emergency and identification card of each child in care.

During today's inspection, deficiencies were cited under CCR Title 22 Division 12.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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.
LPA discussed the safe sleep regulations with licensee Samantha Stegenga and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.



Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Samantha Stegenga.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 SAMANTHA STEGENGA HARMONY KIDS
FACILITY NUMBER: 426213814
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(1)
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: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above, Licensee stated she recently purchased the fire extinguisher however receipt was not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2022
Plan of Correction
1
2
3
4
Licensee agreed to provide proof of purchase of the fire extinguiser no later thatn 2/14/2022 to show that it was pruchse within the 1 year period.
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record reviewthe licensee did not comply with the section cited above Licensee's CPR and First Aid expired on 3/302021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/21/2022
Plan of Correction
1
2
3
4
Licensee agreed to renew the Pediatric CPR and First Aid Certificate and submit the proof no later thatn 2/21/2022.
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: Gigi ReyesTELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3