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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214052
Report Date: 12/22/2021
Date Signed: 12/22/2021 01:53:50 PM

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: 5DATE:
12/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Julie Ayala TIME COMPLETED:
02:15 PM
NARRATIVE
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Due to COVID-19 pandemic, LPA asked the pre-screening questions prior to inspection. Licensee's responses indicate there was no COVID-19 exposure on site.

On 12/22/2021, at 10:02 AM, Licensing Program Analyst (LPA) Martina Jimenez conducted an unannounced Required Annual Inspection of the Ayala Family Child Care Home. LPA met with Licensee Julie Ayala, Licensee, Oscar Ayala, Co-licensee, Saima Ayala, Assistant and Maily Paola Ayala, licensee's daughter. The purpose of the visit was discussed with the Licensee and together we toured the inside and outside of the home. LPA observed 5 children in care at the time of the inspection.

At approximately 10:35 AM, LPA interviewed licensee and co-licensee for the Annual Inspection. During the interviews it was confirmed that Maily Paola Ayala, licensee's adult daughter is a resident of the home. Licensee's adult daughter, Maily Paola Ayala does not have a criminal record clearance to reside in the home.
During the visit LPA provided licensee with documentation regarding Criminal Record Clearance. The following CCR, Title 22, Division 12 regulation was cited: 102370 (d)(1) Criminal Record Clearance.

The main day care areas are living room, dining room, kitchen, 1- bedroom and 2 hallway bathrooms. LPA observed in the children's bathrooms and kitchen Lysol disinfecting spray, disinfecting wipes, and toothpaste, anti-itching cream, melatonin, Perfume, and lotion accessible to children in care. LPA observed the day care area to be clean and orderly. LPA observed age appropriate books, toy, games, tables and chairs. LPA observed the off-limits areas which include the 2 bedrooms secured with doorknob locks on the doors. The backyard is completely fenced. No bodies of water were observed.

THIS REPORT CONTINUES ON LIC 809C & LIC 809D
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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: 12/22/2021
NARRATIVE
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Licensee stated that there are no weapons/ammunition in the home. Licensee stated she does not hold a foster family license. LPA reviewed the facility roster. The fire extinguisher was observed and was serviced August 10, 2021. There is a functioning carbon monoxide detector and smoke alarm that were tested at 10:31am, in the home, that meets statutory requirements. The licensee, co-licensee, and assistant are current with immunization required per SB 792. The last Safety drill was completed and documented was December 22, 2021. Licensee is current with CPR and First Aid which expires July 29, 202.

Licensee is not providing Incidental Medical Services. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes 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: htttp://www.ada.gov/childqanda.htm

Licensee completed the Mandated Reporter Training required per AB 1207, on July 29, 2021. LPA reviewed with Licensee the Safe Sleep Regulation (PIN 20-24-CCP) Safe Sleep Plan (LIC 9227) COVID-19 Guidance (6/29/2021), and Guidance for the use of face coverings (December 13, 2021). LPA provided a Handout for Reporting Child Abuse and Neglect Training provided on line at www.ccld.ca.gov.

Licensee was reminded that it is her responsibility to know the regulations for Family Child Care Home and was advised to review Quarterly Updates and Provider Information Notices (PINs), Title 22 & Health & Safety Codes which can be accessed on-line athttps://www.cdss.ca.gov/inforesources/child-care-licensing

Today’s visit was conducted in Spanish.

Today, deficiency cited under Title 22 Division 12 Appeal rights given.


Upon receipt of this report, licensee shall post and provide copies of this licensing report to parents /guardian of children in care at the facility and to parent/guardians of children newly enrolled at the facility during the next 12 months. Licensee to provide LIC 9224 for each child in care and have each parent sign the form that they have received a copy of the report LIC 809 and LIC 809 D.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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: AYALA FCC AKA JULIE'S HOME DAY CARE
FACILITY NUMBER: 426214052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)(4)
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: (4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, the licensee did not comply with the section cited above in the children's bathrooms and kitchen Lysol disinfecting spray, disinfecting wipes, and toothpaste, anti-itching cream, melatonin, Perfume, and lotion accessible to children in care. Which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2021
Plan of Correction
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Licensee will submit photos via email, of bathrooms and kitchen Toxins (Lysol disinfecting spray, disinfecting wipes, and toothpaste, anti-itching cream, melatonin, Perfume, lotion, etc,) are inaccessible to children in care.

Martina.Jimenez@dss.ca.gov
Type A
Section Cited
CCR
102370(d)(1)
Criminal Record Clearance
(d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, interview with licensee, co-licensee and record review, the licensee did not comply with the section cited above in 102370(d)(1). LPA interviewed Julie Ayala, licensee and Oscar Ayala, co-licensee for the Annual Inspection. During the interviews it was revealed and confirmed that Maily Paola Ayala, licensee's adult daughter is a resident of the home. Licensee's daughter, Maily Paola Ayala does not have a criminal record clearance to reside in the home.


which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/23/2021
Plan of Correction
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Licensee's daughter, Maily Paola Ayala, must get a criminal record clearance and submit all documents to the Community Care Licensing (CCL) by 12/23/2021. A $500 civil penalty was assessed
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: Martina JimenezTELEPHONE: (805) 387-5041
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2021
LIC809 (FAS) - (06/04)
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