426213814-3-16-2025-17-CC-GRES-DEHQUF-20250306112842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 426213814
Report Date: 03/06/2025
Date Signed: 03/16/2025 07:50:04 PM

Document Has Been Signed on 03/16/2025 07:50 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/ DIRECTOR:	SAMANTHA STEGENGA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 423-3527
CITY:	ORCUTT	STATE: CA	ZIP CODE:	93455
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 7	DATE:	03/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Samantha Stegenga		TIME VISIT/ INSPECTION COMPLETED:	11:35 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 March 6, 2025 at 9:15 AM, Licensing Program Analyst (LPA) Gigi conducted an unannounced Annual Random inspection and at the above Family Childcare Home (FCCH) and met with Licensee, Samantha Stegenga. FCCH operating hours are Tuesday, Wednesday, Thursday, 8:45 AM to 1:30 PM, Licensee provides care to children 3- 5 years old. During the inspection, LPA and Licensee toured the inside and outside of the home. LPA observed 6 children in care under the supervision of licensee. The Accessible area in the home includes living room, the playroom, one bathroom and fenced backyard. The dining area, kitchen garage and bedrooms remain inaccessible to children. A baby fence separates the day care area from kitchen and dining and family room. The required licensing forms are posted in the prominent location. LPA observed age-appropriate toys and equipment inside the home. The outdoor space is free of any tripping hazards, age-appropriate play structure was also observed. Knives and cleaning materials are stored inaccessible to the children in care. The bathroom for children’s use is free of toxins. LPA reviewed the facility file and found that the Pediatric CPR and First Aid certificate expires on 3/16/2026 while Mandated Reporter Training Certificate expired on 2/23/2025. LPA reminded Licensee that it is their responsibility to renew the certificates every two years. The regulation fire extinguisher was purchased on 12/29/2023. Carbon monoxide and smoke detectors were observed. FCCH conducts fire and disaster drill every month and last drill was conducted on 2/13/2025

Maria Mueller	TELEPHONE: (805) 562-0410
Gigi Reyes	TELEPHONE: (805) 698-7114
	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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: 03/06/2025

NARRATIVE

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Review of children's files revealed that Child 4 and Child # 6 have no immunization record on file. Nobodies of water was observed. Licensee confirmed there are no firearms and ammunition in the home.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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/inspection-process.

Licensee, was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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: 03/06/2025

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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, 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 is not providing Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.

During the exit interview, the LICENSEE, Samantha Stegenga confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

During today’s inspection, two type B deficiencies were cited.

Notice of Site Visit was issued and must be posted for 30 days.

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: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/16/2025 07:50 PM - It Cannot Be Edited

Created By: Gigi Reyes On 03/06/2025 at 11:01 AM

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: STEGENGA FCC AKA SAMANTHA STEGENGA HARMONY KIDS	FACILITY NUMBER: 426213814
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2025

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, the licensee did not comply with the section cited above , Fire Extinguisher was purchased on 12/29/2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2025
	Plan of Correction
1 2 3 4	Licensee agreed to purchase a new regulation fire extinguisher and send the receipt no later thatn 3/17/2025.

Type B

Section Cited

CCR

102418(a)

Immunizations

(a) Prior to admission to a family day care home, children shall be immunized against diseases as required by the California Code of Regulations, Title 17, beginning with Section 6000. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Childe # 4 and Child 6 did not have a immunization record on file which poses/posed a potential health, safety or personal rights risk to person in care.
	POC Due Date: 03/17/2025
	Plan of Correction
1 2 3 4	Licensee agreed to submit the plan of correction letter outlining how to ensure that immunization will be obtained prior to admission of a day care childe. Submit no later thatn 3/17/2025.

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:

Gigi Reyes

TELEPHONE: (805) 698-7114

LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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