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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426214898
Report Date: 08/23/2022
Date Signed: 08/25/2022 09:19:11 AM


Document Has Been Signed on 08/25/2022 09:19 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:MEDINA FAMILY CHILD CAREFACILITY NUMBER:
426214898
ADMINISTRATOR:MARIA MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 346-2571
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:14CENSUS: 8DATE:
08/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Maria MedinaTIME COMPLETED:
04:33 PM
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On 8/23/22, Licensing Program Analyst (LPA) Francisca Velazquez conducted an unannounced One Year Required Inspection of the abovementioned Family Child Care Home (FCCH). LPA met with Maria Medina, Licensee of the FCCH and explained the purpose of the inspection. LPA, in the company of Licensee toured the interior and exterior of the FCCH. The following areas are used for child care services; two living rooms, kitchen/dinning area, bathroom, and backyard are used for childcare services. LPA observed a small gate located in the hallway making all bedrooms inaccessible. At the time of the inspection, there are eight (8) children present being cared for by Licensee. LPA notes that there is only one (1) school-age/kindergarten age child and therefore Licensee is operating out of capacity.

The home was clean and orderly and offers plenty of ventilation for the children in care. Further, the home was void of hazardous items. Medication is stored in an elevated kitchen cabinet which is secure and beyond the reach of children. Sharps are stored in kitchen drawers that have magnetic covers. LPA observed cleaning compounds are stored in the laundry room. LPA observed that the laundry room is not locked or inaccessible. LPA observed cleaning solutions located on top of the washer/dryer that were within reach of children in care. Toys, furniture and equipment within the FCCH are age appropriate.

Required forms are predominantly posted on the wall. The FCCH has a fireplace that has a screen but the screen is not secured. LPA observed smoke and carbon monoxide detectors in the FCCH which were each tested at 1:50 PM and found to be operable. LPA observed a regulation fire extinguisher which had a service tag that was not dated therefore, LPA was not able to determine when the fire extinguisher was serviced. LPA reminded the Licensee to either service or purchase a regulation fire extinguisher annually. The home maintains working telephone services.

The backyard is completely fenced and has cement and plenty of shade for the children in care. The fence’s entry/exit gates are secure. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426214898
VISIT DATE: 08/23/2022
NARRATIVE
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Toys and play equipment observed in backyard are age appropriate. No bodies of water are are observed.

LPA reviewed Licensee and children's records. LPAs notes that out of eight children, there were only five children files available for review. Licensee stated that the three children files that are missing are for children that just started services this week. LPA attempted to review Licensee's Mandated Reporter training certification; Licensee did not have certificate for review. Licensee stated that she recently renewed her AB1207 certificate but it was printed with the wrong name. Licensee showed LPA an email thread between Licensee and trainer discussing how to correct this error. Per trainer, Licensee will have to retake the course again 9/8/22. LPA reviewed Licensee's Pediatric CPR and First Aid that was completed on 1/8/21. The Licensee informed LPA no firearms and ammunition are on site.

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: http://www.ada.gov/childqanda.htm

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.

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
for 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.

Type B deficiencies are being cited during today's inspection. CONT 809-C
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
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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: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426214898
VISIT DATE: 08/23/2022
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Licensee was provided a copy of their appeal rights.

A Notice of Site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed in Spanish with Licensee, Maria Medina.
SUPERVISOR'S NAME: Maria MuellerTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 08/25/2022 09:19 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: MEDINA FAMILY CHILD CARE
FACILITY NUMBER: 426214898

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
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 observation, the licensee did not comply with the section cited above in that LPA observed a fire extinguisher that did not have a service tag, a fireplace that was accessible to chidlren and cleaning compounds that were within reach of chidlren which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2022
Plan of Correction
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Licensee agrees to get an update fier extinguisher with service tag that shows date of service. Licensee agrees to secure the fireplace to ensure it is inaccessible to chidlren in care. Licensee agrees to lock the laundry room to make sure all cleaning compounds are inacessible to children in care. Licensee will email proof of correction by 8/30/22 via email to francisca.velazquez@dss.ca.gov
Type B
Section Cited
CCR
102416.5(b)(3)
Staffing Ratio and Capacity
(b) For a Small Family Child Care Home, the maximum number of children for whom care may be provided at any one time, including children under age 10 who reside at the licensee's home, shall be one of the following: (3) More than six and up to eight children, without an additional adult attendant, only if the criteria in
Section 1597.44 of the Health and Safety Code are met.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Licensee was providing care and supervision for eight children and only one child was in Kindergarten, all other children are younger which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2022
Plan of Correction
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Licensee agrees to write a summary of how she will ensure to meet ratio capacity when only one adult is present. Licensee will email summary by 8/30/22 via email to francisca.velazquez@dss.ca.gov

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: Francisca VelazquezTELEPHONE: (805) 883-8244
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
LIC809 (FAS) - (06/04)
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