426213814-2-7-2023-17-CC-GRES-CNTUZU-20230207150208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426213814
Report Date: 02/07/2023
Date Signed: 02/07/2023 03:02:11 PM

Document Has Been Signed on 02/07/2023 03:02 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:	STEGENGA FCC AKA SAMANTHA STEGENGA HARMONY KIDS		FACILITY NUMBER:	426213814
ADMINISTRATOR:	SAMANTHA STEGENGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 423-3527
CITY:	ORCUTT	STATE: CA	ZIP CODE:	93455
CAPACITY:	14	CENSUS: 6	DATE:	02/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Samantha		TIME COMPLETED:	02:00 PM

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 7, 2023 at 12:00 PM, Licensing Program Analyst (LPA) Gigi Reyes conducted an unannounced One (1) Year Required inspection. LPA asked pre- screening questions related to COVID- 19 and licensee’s responses indicate there are no COVID-19 exposures on site. LPA met with licensee, Samantha Stegenga and discussed the purpose of the inspection. There were 6 children present at the time of the inspection. LPA in the company of Licensee toured the interior and exterior of the day care. Family Child Care Home (FCCH) uses the family room, bathroom, backyard and hallway. Off limit areas are garage, 3 bedrooms kitchen. Living room, hallway to the bedroom, kitchen and dining areas are barricaded making them inaccessible to day care children. LPA observed required licensing forms are posted in the wall. LPA observed smoke and carbon monoxide detectors in the home. The fire extinguisher was purchased on 9/28/2022. Licensee was reminded that fire extinguisher should be serviced every year or to purchase a new one. Home conducts and documents fire and disaster drill every month, last drill was conducted on 1/30/2023. Bathroom was observed to be free of toxins. Hazardous items and cleaning materials are kept inaccessible to day care children. The backyard is completely fenced. LPA observed the trampoline and explained to licensee the conditions for the use of trampoline. Licensee stated that trampoline will not be used by day care children, it will remain locked and inaccessible during day care hours. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home. LPA reviewed facility file, Pediatric CPR and First Aid expires on 3/16/2024. Licensee's the Mandated Reporter Training certificate will expire on 2/21/2022. Licensee was reminded to renew the Mandated Reporter Training. Licensee has proof of immunization per SB 792 against pertussis, measles and a waiver for flu. FCCH has current roster of children in care. A sampling of children records were reviewed and found to be current. File contains Emergency and Identification card requirements and affidavit regarding liability insurance signed by the parents. Continued on LIC 809C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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 SAMANTHA STEGENGA HARMONY KIDS	FACILITY NUMBER: 426213814
	VISIT DATE: 02/07/2023

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

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.

LPA discussed the safe sleep regulations with licensee 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
Licensee was reminded that all adults 18 year old 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.

During today's inspection, no deficiency was cited. Appeal Rights were given and discussed.
A notice of site visit was posted The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with the licensee, Samantha Stegenga

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Gigi Reyes	TELEPHONE: (805) 698-7114
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC809 (FAS) - (06/04)

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