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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214269
Report Date: 08/13/2024
Date Signed: 08/13/2024 11:07:41 AM


Document Has Been Signed on 08/13/2024 11:07 AM - 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:ACOSTA FCC AKA LITTLE ANGEL'S DAYCAREFACILITY NUMBER:
426214269
ADMINISTRATOR:GABRIELA ACOSTAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 623-8555
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:14CENSUS: 6DATE:
08/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Gabriela AcostaTIME COMPLETED:
11:15 AM
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On 8/13/24, at 9:15 AM, Licensing Program Analyst (LPA) Elvin Baddley conducted an unannounced Annual/Random Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Gabriela Acosta, Licensee of the FCCH, and explained the nature and purpose of the inspection. LPA, in the company of the Licensee, toured the exterior and interior of the FCCH. The FCCH is a three bedroom, three bathroom two story dwelling. The FCCH's living room, family room, dining room, kitchen, down stairs bathroom and backyard are used for child care, while the remainder of the home is excluded from child care. LPA observed a child safety gate at the base of the stairwell to the upper level of the home. At the time of the inspection, LPA observed six children (one biological) present, along with an Assistant (cleared and associated). LPA notes two children are napping during the time of the inspection.

The FCCH is orderly. Required licensing forms and documents are posted on the wall in the FCCH's living room. Cleaning compounds in the FCCH are secured underneath the kitchen sink, while sharps are observed atop of the refrigerator which is beyond the reach of children in care. Medication is secured in the bathroom cabinet underneath the sink. The FCCH has fireplace which is screened. LPA observed the bathroom used by children in care to be clean and free of toxins. LPA observed smoke and carbon monoxide detectors throughout the FCCH. A smoke and carbon monoxide detectors in the living room are tested at 10:44 AM and found to be operable. The FCCH has a regulation fire extinguisher which was purchased on 3/27/24. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. Toys, furniture and play equipment observed in the FCCH are age appropriate. The home maintains working telephone services.

Outdoor activities at the FCCH take place in the backyard. The backyard of the FCCH is enclosed by wooden fencing and the footing in the area is varied. LPA observed the entry/exits gates to the backyard area to be secured. LPA observed a shed in the backyard. The shed contains household items. LPA notes shed is secure and inaccessible to children in care. Toys and play equipment observed in backyard area are age appropriate. Licensee is reminded to replace toys and play equipment when such items begin to degrade or are not in good repair. LPA observed no bodies of water on site.
(CONT. 809-C, Page 2)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024
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 4


Document Has Been Signed on 08/13/2024 11:07 AM - It Cannot Be Edited

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: ACOSTA FCC AKA LITTLE ANGEL'S DAYCARE
FACILITY NUMBER: 426214269

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/ interview/ record review, the Licensee did not comply with the section cited above as the LIcensee and Assistant (A1) do not have current certifications for Mandated Reporter training, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Licensee to provided CCLD (elvin.baddley@dss.ca.gov) current Mandated Reporter certifications for Licensee and Assistant (A1) no later than the closed of business (5:00 PM) on 8/27/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: ACOSTA FCC AKA LITTLE ANGEL'S DAYCARE
FACILITY NUMBER: 426214269
VISIT DATE: 08/13/2024
NARRATIVE
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LPA reviewed a sampling of children records. The records are current, complete and contained emergency contact information, immunization records and sleep logs, among other required licensing documents. LPA reviewed Licensee's Pedantic CPR and First Aid (EMSA approved) certifications which are current and have an expiration date of 8/9/25. At 9:50 AM, LPA reviewed Licensee's Mandated Reporter training certification. The certification for both the Licensee and Assistant are expired. LPA reminded Licensee of the responsible to ensure training and certifications are current. The FCCH has two dogs on site. Licensee informed LPA vaccination records for each of the dogs are current. The Licensee informed LPA firearm and ammunition are stored on site. LPA reviewed storage of the aforementioned and notes firearm and ammunition are stored separately, inaccessible to children in care and in an excluded area of the FCCH. LPA reviewed the FCCH's fire drill logs and notes the most recent fire drill occurred on 4/5/24.

The facility does not provide Incidental Medical Services (IMS). IMS policy was discussed. For IMS information see PIN 22-02CCP. 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) or (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 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 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, 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.
(CONT. 809-C, Page 3)
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ACOSTA FCC AKA LITTLE ANGEL'S DAYCARE
FACILITY NUMBER: 426214269
VISIT DATE: 08/13/2024
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During the exit interview, the Licensee confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS on 8/13/24.

A Type B Deficiency is being cited based on LPAs' observation/interviews/record reviews pursuant to Title 22 of the CA Code of Regulations and HSC 1596.8662 (refer to LIC 809-D). Licensee was provided a copy of their Appeal Rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee Gabriela Acosta.

SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Elvin BaddleyTELEPHONE: (805) 635-4697
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4