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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214052
Report Date: 12/19/2019
Date Signed: 12/19/2019 04:27:05 PM

COMPREHENSIVE INSPECTION
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:AYALA FCC AKA JULIE'S HOME DAY CAREFACILITY NUMBER:
426214052
ADMINISTRATOR:JULIE AYALAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 737-3040
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:14CENSUS: 8DATE:
12/19/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Julie Ayala and Saima AyalaTIME COMPLETED:
04:35 PM
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A comprehensive required inspection was conducted by Licensing Program Analyst (LPA) S. Mendoza-Ceja who met with Licensee's adult daughter Saima Ayala. Saima Ayala and her sister were providing care to four children in the home while Licensee Julie Ayala was picking up four (4) school age children. Saima Ayala escorted LPA through the home which included the living room, dinning area, bedrooms, two restrooms, and backyard. LPA observed two children napping (one in the master bedroom and another bedroom). Licensee Julie Ayala arrived approximately 15 minutes later with four (4) school age children. Licensee stated there are no firearms/ammunition or bodies of water on the premises. LPA did not observe any bodies of water. There is a smoke detector and carbon monoxide detector in the home which were tested and operational. There is a 2 A10 BC Fire Extinguisher which is current, purchased 07/16/2019. Licensee was reminded the fire extinguisher needs to be replaced or serviced yearly. The last fire drill documented is 05/09/2019. LPA advised Licensee she needs to conduct a fire drill and disaster drills at least once every six months and document LPA reviewed children's records, including the child care roster. LPA reviewed the handouts "A Child Care Provider's Guide to Safe Sleep, Safe Sleep in Child Care, and Effects of Lead Exposure". LPA reviewed current CPR and First Aid for Licensee Julie Ayala, Oscar Ayala, Saima Ayala, and Maria Vargas. LPA discussed the requirement for care providers/employees and volunteers to obtain immunization against Influenza, Pertussis, and Measles. Verification is on file for Licensee Julie Ayala, Saima Ayala, Oscar Ayala, and Maria Vargas.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
VISIT DATE: 12/19/2019
NARRATIVE
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The following Type B deficiency is cited according to CCR, Title 22, Division 12 regarding the fire and emergency disaster drill not conducted within the time frame as required by the Department.

An exit interview was conducted and a Plan of Correction was reviewed and developed with the Ms. Ayala. A copy of this report and appeal rights were discussed and left with Ms. Ayala, whose signature on this form confirms receipt of these documents

The Notice of Site Visit was posted at the visit.

FAILURE TO POST THE NOTICE OF SITE VISIT FOR 30 DAYS MAY RESULT IN A $100.00 CIVIL PENALTY.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2019
Section Cited

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102417(g)(9)(A)1 Operation of a FCCH: Each family child care home shall conduct fire drills and disaster drills at least once every six months. The licensee shall document the drills, including the date and time of each drill. This documentation shall be kept at the family child care home.
This requriement was not met
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evidenced by LPAs observation, interview, and review of records that revealed the last fire drill/and or diaster drill was conducted on May 9, 2019 which is over six months. This poses a potential risk to the health and safety of chidlren in care.
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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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Sylvia Mendoza-CejaTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3