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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 426215015
Report Date: 11/22/2024
Date Signed: 11/22/2024 12:07:17 PM

Document Has Been Signed on 11/22/2024 12:07 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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:PONCE FAMILY CHILD CAREFACILITY NUMBER:
426215015
ADMINISTRATOR/
DIRECTOR:
GUADALUPE PONCEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 739-0595
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
11/22/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:56 AM
MET WITH:Guadalupe PonceTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On November 22,2024 at 9:56AM Licensing Program Analyst (LPA) Giovani Gonzalez conducted an unannounced Required - 3 Year inspection at the above-mentioned Family Child Care Home (FCCH). LPA met with licensee Guadalupe Ponce and informed them the purpose of the inspection. At the time of the inspection 4 children and 1 assistant were present.

LPA in the company of the licensee toured the interior and exterior of the home. LPA observed the interior of the home to be clean and orderly. LPA observed the living room has sufficient ventilation for children and is free of hazards. LPA observed a fire place that is covered and inaccessible to children in care. LPA observed the kitchen is accessible and that all lower kitchen cabinets/drawers are free of hazards. LPA observed sharps to be stored in an elevated kitchen cabinet beyond the reach of children in care. LPA observed the door leading to the garage to be secured with a child proof lock. Licensee informed LPA medication and cleaning compounds are stored in the locked garage. LPA observed a sun room with required postings and to be free of hazards. Licensee informed LPA currently it is mostly being used to store children's equipment. LPA observed the interior bathroom used for children to be clean and free of hazards. LPA reminded licensee to ensure all hygiene products are inaccessible to children. LPA observed all bedroom doors to be secured with child proof locks.

LPA observed the exterior of the home to be completely enclosed and the exit/entry way to be secured. LPA observed plenty of space, shading and equipment for children in care. LPA observed the outdoor patio to have 2 more bathrooms for children which were clean and free of hazards. LPA observed play equipment to be in good condition. LPA observed a storage shed that contains children's equipment that has the ability to be locked.

The FCCH has a smoke and carbon monoxide detector which was tested at 10:15AM and found in working order. LPA observed the FCCH to have a regulation fire extinguisher which was serviced on 5/20/2024. LPA reminded Licensee to either service or purchase a regulation fire extinguisher annually.
CONTINUED PAGE 2
Ana TolentinoTELEPHONE: (805) 562-0347
Giovani GonzalezTELEPHONE: (805) 722-5132
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PONCE FAMILY CHILD CARE
FACILITY NUMBER: 426215015
VISIT DATE: 11/22/2024
NARRATIVE
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LPA reviewed files of 4 children present which were found to be current and complete. LPA notes Safe Sleep documents were not reviewed as licensee was not caring for any infants. LPA reminded licensee when they care for infants they must follow all Safe Sleep regulations. LPA reviewed licensee's and assistant's files which were found to be current and complete. Both licensee and assistant have a current Mandated Reporter Training certificate (expires 10/15/2025) and current Pediatric CPR/First Aid(expires 11/15/2025). LPA reminded Licensee that it is their responsibility to ensure all training and certifications are current.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

Licensee was reminded that all adults 18 and over living or working in the home, 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.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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: https://www.ada.gov/resources/child-care-centers/.
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SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
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
CENTRAL COAST-CHILD, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: PONCE FAMILY CHILD CARE
FACILITY NUMBER: 426215015
VISIT DATE: 11/22/2024
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

No deficiencies were issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Guadalupe Ponce . Appeal Rights were given.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0347
LICENSING EVALUATOR NAME: Giovani GonzalezTELEPHONE: (805) 722-5132
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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