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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
426214393
Report Date:
06/23/2022
Date Signed:
06/23/2022 05:33:27 PM
Document Has Been Signed on
06/23/2022 05:33 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
ADMINISTRATOR:
LUCIA J. WILSON
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(805) 717-9529
CITY:
LOMPOC
STATE:
CA
ZIP CODE:
93436
CAPACITY:
14
CENSUS:
7
DATE:
06/23/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:40 PM
MET WITH:
Lucia Wilson
TIME COMPLETED:
05:33 PM
NARRATIVE
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n June 23, 2022 at 12:50 PM Licensing Program Analyst Gigi Reyes conducted an unannounced 1 Year Required Inspection, LPA asked pre screening questions related to COVID- 19, licensee’s responses indicate there are no COVID 19 exposures on site. LPA met with licensee, Ms. Lucia Wilson and discussed the purpose of the inspection. There were 7 children present at the time of the inspection, licensee's assistant arrived at a later time.
The Family Child Care Home (FCCH) was toured inside and out. LPA observed required licensing forms are posted in the home. LPA observed ant repellant and multi purpose cleanser on the counter top accessible to day care children. It was observed that living room is being used for napping which was previously off limits to daycare children. LPA observed smoke and carbon monoxide detectors in the FCCH. Fire extinguisher was serviced on 6/23/2022. Licensee was reminded to service it or purchase every year. Licensee stated home conducts fire and disaster drill every 3 months, however there was no documentation. The play yard is enclosed by wooden fence. LPA observed age appropriate toys and play equipment. No bodies of water were observed on site. Licensee stated there are no guns or ammunition in the home.
LPA Reyes reviewed facility file, Pediatric CPR and First Aid expires on 12/2023 Licensee's Mandated Reporter Training expired on 11/12/2021. Licensee and assistant have no proof of immunization. A sampling of children records was reviewed. LPA observed that
C1, 's immunization record is not up to date, C2, C3 and C4 immunization are not recorded in PM 286
During today's inspection, deficiencies were cited under Title 22 Division 12.
Continued on 809-C
SUPERVISOR'S NAME:
Maria Mueller
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Gigi Reyes
TELEPHONE:
(805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE:
06/23/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
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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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
VISIT DATE:
06/23/2022
NARRATIVE
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During today's inspection, deficiencies were cited under Title 22 Division 12 and Health and Safety Code.
LPA Reyes informed licensee Ms. Wilson that this report dated 6/23/2022 documents one (1) Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.Also, LPA Reyes informed the licensee, Ms. Wilson to provide a copy of this licensing report dated 6/23/2022
that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verific
ation.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home 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:
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
.
SUPERVISOR'S NAME:
Maria Mueller
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Gigi Reyes
TELEPHONE:
(805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE:
06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
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Document Has Been Signed on
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- 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/23/2022
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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2
3
4
Based on observation the licensee did not comply with the section cited above, ant repellant and multipurpose cleanser were observed on the countertop accessible to children which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
06/23/2022
Plan of Correction
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2
3
4
During the inspection, Licensee kept the ant repelant and cleanser in the garage keeping it inaccessible to day care children. Lcensee shall submit written plan of correction to Coomunity Care Licensin g(CCL) no later thatn 6/24/2022
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
06/23/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
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Document Has Been Signed on
06/23/2022 05:33 PM
- 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/23/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)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: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months. 1. The licensee shall document the drills, including the date and time of each drill. This documentation shall kept at the family child care home.
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, licensee stated FCCH conducts fire and idsaster drill every 3 months however, there was no documentation of the said drill which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
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2
3
4
Licensee agreed to document the fire and disaster drill and to submit proof of correction to CCL no later than 7/5/2022.
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:
06/23/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
LIC809
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Document Has Been Signed on
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- 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/23/2022
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
1
2
3
4
Based on record review the licensee did not comply with the section cited above Licensee and assistant did not renew the Mandated Reporter Training which certificate expired on 11/12/2021 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
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2
3
4
Licensee and assistant agreed to renew the Mandated Reporter Training and submit proof to CCL no later thatn July 5, 2022.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.
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, Licensee and assistant did not have proof of immunization on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
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2
3
4
Licensee and assistant agreed to obtain the immunization and submit proof to CCL no later than 7/5/2022.
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:
06/23/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
LIC809
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Document Has Been Signed on
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- 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/23/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.3(a)(6)
Alterations to Existing Building or Grounds
(a) Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed changed, including, but not limited to, the following: (6) Any change from an area of the family child care home previously identified as "off limits" to an area where care and supervision will be provided to children in care.
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, FCCH uses the living room which was previously identified as off limits from day care children prior to notiying the Department which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
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2
3
4
Licensee agreed to submit a new facility sketch and written proof of correction to CCL no later than 7/5/2022.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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 Licensee and assistant do not have proof of immunization on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
1
2
3
4
Licensee agreed to submit proof of correction to CCL no later thatn 7/5/2022.
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:
06/23/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
LIC809
(FAS) - (06/04)
Page:
6
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Document Has Been Signed on
06/23/2022 05:33 PM
- 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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
06/23/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)(1)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled. (1) This requirement includes updating each child's PM 286 (6/95) when the child is due to receive required immunizations after enrollment in the family day care home.
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 C1, 's immunization record is not up to date, C4, C6 and C7 immunization are not recorded in PM 286 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/05/2022
Plan of Correction
1
2
3
4
Licensee agreed to obtain the immunization of day care children and update/record them in PM/CDPH 286. Licensee shall submit written proof of correciton to CCL no later than 7/5/2022
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:
06/23/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
LIC809
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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:
WILSON FAMILY CHILD CARE
FACILITY NUMBER:
426214393
VISIT DATE:
06/23/2022
NARRATIVE
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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 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 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.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the licensee, Ms. Lucia Wilson
SUPERVISOR'S NAME:
Maria Mueller
TELEPHONE:
(805) 562-0410
LICENSING EVALUATOR NAME:
Gigi Reyes
TELEPHONE:
(805) 698-7114
LICENSING EVALUATOR SIGNATURE:
DATE:
06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2022
LIC809
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